{ "hospital_name": "Saint Marys Hospital", "last_updated_on": "2026-03-17", "version": "3.0", "location_name": [ "Saint Marys Hospital" ], "hospital_address": [ "350 Boulevard Passaic, NJ 07055" ], "license_information": { "license_number": "463499370", "state": "NJ" }, "attestation": { "attestation": "To the best of its knowledge and belief, this hospital has included all applicable standard charge information in accordance with the requirements of 45 CFR 180.50, and the information encoded is true, accurate, and complete as of the date in the file. This hospital has included all payer-specific negotiated charges in dollars that can be expressed as a dollar amount. For payer-specific negotiated charges that cannot be expressed as a dollar amount in the machine-readable file or not knowable in advance, the hospital attests that the payer-specific negotiated charge is based on a contractual algorithm, percentage or formula that precludes the provision of a dollar amount and has provided all necessary information available to the hospital for the public to be able to derive the dollar amount, including, but not limited to, the specific fee schedule or components referenced in such percentage, algorithm or formula.", "confirm_attestation": true, "attester_name": "Edward Condit" }, "type_2_npi": [ "1770901761", "1831722586", "1730508250" ], "standard_charge_information": [ { "description": "Hc Chest Wall Manipulation,Initial", "code_information": [ { "code": "94667", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 524.41, "discounted_cash": 157.0, "minimum": 100.1099, "maximum": 524.41, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 333.45, "additional_payer_notes": "212.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medical Rental Network", "methodology": "fee schedule", "standard_charge_dollar": 333.45, "additional_payer_notes": "212.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 157.29, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "ALLY-ALIGN (FKA SPARTAN PLAN NJ, INC.)", "plan_name": "ALLY-ALIGN (FKA SPARTAN PLAN NJ, INC.)", "methodology": "fee schedule", "standard_charge_dollar": 165.15, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Americhoice (UHC)", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 157.29, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Amerihealth", "plan_name": "Amerihealth Medicare", "methodology": "fee schedule", "standard_charge_dollar": 157.29, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 231.14, "additional_payer_notes": "146.95% of Medicare Rates" }, { "payer_name": "Clover Health", "plan_name": "Clover Medicare", "methodology": "fee schedule", "standard_charge_dollar": 157.29, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Coventry", "plan_name": "Coventry Auto", "methodology": "fee schedule", "standard_charge_dollar": 314.58, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Coventry", "plan_name": "Coventry Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 314.58, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "fee schedule", "standard_charge_dollar": 220.21, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Fairprice Healthcare Holdings", "plan_name": "Fairprice Healthcare Holdings", "methodology": "fee schedule", "standard_charge_dollar": 251.66, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ HMO POS", "methodology": "fee schedule", "standard_charge_dollar": 278.88, "additional_payer_notes": "177.30% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ Indemnity", "methodology": "fee schedule", "standard_charge_dollar": 278.88, "additional_payer_notes": "177.30% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ PPO", "methodology": "fee schedule", "standard_charge_dollar": 278.88, "additional_payer_notes": "177.30% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon Medicare", "methodology": "fee schedule", "standard_charge_dollar": 157.29, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon NJ Health Medicaid", "methodology": "percent of total billed charges", "standard_charge_percentage": 19.58, "median_amount": 102.68, "10th_percentile": 102.68, "90th_percentile": 102.68, "count": "1 through 10" }, { "payer_name": "Humana", "plan_name": "Humana Military Tricare", "methodology": "fee schedule", "standard_charge_dollar": 125.83, "additional_payer_notes": "80.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 157.29, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 157.29, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC All Payer (02-01-2023 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 524.41 }, { "payer_name": "UHC", "plan_name": "UHC Oxford (02-01-2023 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 524.41 }, { "payer_name": "UHC - Adhoc", "plan_name": "UHC - Adhoc All Payer", "methodology": "fee schedule", "standard_charge_dollar": 524.41 }, { "payer_name": "UHC - Adhoc", "plan_name": "UHC - Adhoc Oxford", "methodology": "fee schedule", "standard_charge_dollar": 524.41 }, { "payer_name": "Wellcare", "plan_name": "Wellcare Insurance Exchange", "methodology": "fee schedule", "standard_charge_dollar": 212.34, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 157.29, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup Medicare", "methodology": "fee schedule", "standard_charge_dollar": 157.29, "additional_payer_notes": "100.00% of Medicare Rates" } ] } ] }, { "description": "Destroy ls facet jnt addl", "code_information": [ { "code": "64636", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 4654.0, "minimum": 888.4486, "maximum": 3723.2, "payers_information": [ { "payer_name": "Horizon", "plan_name": "Horizon NJ Health Medicaid", "methodology": "percent of total billed charges", "standard_charge_percentage": 19.58, "median_amount": 847.32, "10th_percentile": 847.32, "90th_percentile": 847.32, "count": "1 through 10" }, { "payer_name": "UHC", "plan_name": "UHC All Payer (02-01-2023 to 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 3057.0 }, { "payer_name": "UHC", "plan_name": "UHC Oxford (02-01-2023 to 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 2297.0 }, { "payer_name": "UHC - Adhoc", "plan_name": "UHC - Adhoc All Payer", "methodology": "case rate", "standard_charge_dollar": 3245.0 }, { "payer_name": "UHC - Adhoc", "plan_name": "UHC - Adhoc Oxford", "methodology": "case rate", "standard_charge_dollar": 2367.0 }, { "payer_name": "Wellchoice", "plan_name": "WELLCHOICE HMO of NJ (Empire) Commercial (HMO / HMO POS, PPO)", "methodology": "case rate", "standard_charge_dollar": 1715.0 }, { "payer_name": "Wellchoice", "plan_name": "WELLCHOICE HMO of NJ (Empire) Commercial (Indemnity)", "methodology": "case rate", "standard_charge_dollar": 1978.0 } ] } ] }, { "description": "Hc Deoxyribonuclease, Antibody", "code_information": [ { "code": "86215", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 98.0, "discounted_cash": 13.0, "minimum": 7.95, "maximum": 83.3, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 28.09, "additional_payer_notes": "212.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medical Rental Network", "methodology": "fee schedule", "standard_charge_dollar": 28.09, "additional_payer_notes": "212.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 13.25, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "ALLY-ALIGN (FKA SPARTAN PLAN NJ, INC.)", "plan_name": "ALLY-ALIGN (FKA SPARTAN PLAN NJ, INC.)", "methodology": "fee schedule", "standard_charge_dollar": 13.91, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Americhoice (UHC)", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 13.25, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Amerihealth", "plan_name": "Amerihealth Medicare", "methodology": "fee schedule", "standard_charge_dollar": 13.25, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 19.21, "additional_payer_notes": "Laboratory - 145.00% of Medicare Rates" }, { "payer_name": "Clover Health", "plan_name": "Clover Medicare", "methodology": "fee schedule", "standard_charge_dollar": 13.25, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Coventry", "plan_name": "Coventry Auto", "methodology": "fee schedule", "standard_charge_dollar": 26.5, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Coventry", "plan_name": "Coventry Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 26.5, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "fee schedule", "standard_charge_dollar": 18.55, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Fairprice Healthcare Holdings", "plan_name": "Fairprice Healthcare Holdings", "methodology": "fee schedule", "standard_charge_dollar": 15.9, "additional_payer_notes": "Laboratory - 120.00% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ HMO POS", "methodology": "fee schedule", "standard_charge_dollar": 69.19, "additional_payer_notes": "177.30% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ Indemnity", "methodology": "fee schedule", "standard_charge_dollar": 69.19, "additional_payer_notes": "177.30% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ PPO", "methodology": "fee schedule", "standard_charge_dollar": 69.19, "additional_payer_notes": "177.30% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon Medicare", "methodology": "fee schedule", "standard_charge_dollar": 13.25, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Military Tricare", "methodology": "fee schedule", "standard_charge_dollar": 10.6, "additional_payer_notes": "80.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 13.25, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 13.25, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC All Payer (02-01-2023 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 7.95 }, { "payer_name": "UHC", "plan_name": "UHC Medicaid (02/01/2023 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 10.6 }, { "payer_name": "UHC", "plan_name": "UHC Oxford (02-01-2023 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 7.95 }, { "payer_name": "UHC - Adhoc", "plan_name": "UHC - Adhoc All Payer", "methodology": "fee schedule", "standard_charge_dollar": 13.25 }, { "payer_name": "UHC - Adhoc", "plan_name": "UHC - Adhoc Oxford", "methodology": "fee schedule", "standard_charge_dollar": 13.25 }, { "payer_name": "Wellcare", "plan_name": "Wellcare Insurance Exchange", "methodology": "fee schedule", "standard_charge_dollar": 17.89, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 13.25, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup Medicare", "methodology": "fee schedule", "standard_charge_dollar": 13.25, "additional_payer_notes": "100.00% of Medicare Rates" } ] } ] }, { "description": "Hc Mri Brain Contrast", "code_information": [ { "code": "70552", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 4291.36, "discounted_cash": 412.0, "minimum": 329.952, "maximum": 3647.656, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 874.37, "additional_payer_notes": "212.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medical Rental Network", "methodology": "fee schedule", "standard_charge_dollar": 874.37, "additional_payer_notes": "212.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 412.44, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "ALLY-ALIGN (FKA SPARTAN PLAN NJ, INC.)", "plan_name": "ALLY-ALIGN (FKA SPARTAN PLAN NJ, INC.)", "methodology": "fee schedule", "standard_charge_dollar": 433.06, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Americhoice (UHC)", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 412.44, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Amerihealth", "plan_name": "Amerihealth HMO", "methodology": "fee schedule", "standard_charge_dollar": 886.6 }, { "payer_name": "Amerihealth", "plan_name": "Amerihealth Medicare", "methodology": "fee schedule", "standard_charge_dollar": 412.44, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 606.08, "additional_payer_notes": "146.95% of Medicare Rates" }, { "payer_name": "Clover Health", "plan_name": "Clover Medicare", "methodology": "fee schedule", "standard_charge_dollar": 412.44, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Coventry", "plan_name": "Coventry Auto", "methodology": "fee schedule", "standard_charge_dollar": 824.88, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Coventry", "plan_name": "Coventry Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 824.88, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "fee schedule", "standard_charge_dollar": 577.42, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Fairprice Healthcare Holdings", "plan_name": "Fairprice Healthcare Holdings", "methodology": "fee schedule", "standard_charge_dollar": 659.9, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ HMO POS", "methodology": "fee schedule", "standard_charge_dollar": 731.26, "additional_payer_notes": "177.30% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ Indemnity", "methodology": "fee schedule", "standard_charge_dollar": 731.26, "additional_payer_notes": "177.30% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ PPO", "methodology": "fee schedule", "standard_charge_dollar": 731.26, "additional_payer_notes": "177.30% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon Medicare", "methodology": "fee schedule", "standard_charge_dollar": 412.44, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Military Tricare", "methodology": "fee schedule", "standard_charge_dollar": 329.95, "additional_payer_notes": "80.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 412.44, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 412.44, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC All Payer (02-01-2023 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 552.18 }, { "payer_name": "UHC", "plan_name": "UHC Oxford (02-01-2023 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 552.18 }, { "payer_name": "UHC - Adhoc", "plan_name": "UHC - Adhoc All Payer", "methodology": "fee schedule", "standard_charge_dollar": 368.12 }, { "payer_name": "UHC - Adhoc", "plan_name": "UHC - Adhoc Oxford", "methodology": "fee schedule", "standard_charge_dollar": 368.12 }, { "payer_name": "Wellcare", "plan_name": "Wellcare Insurance Exchange", "methodology": "fee schedule", "standard_charge_dollar": 556.79, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 412.44, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup Medicare", "methodology": "fee schedule", "standard_charge_dollar": 412.44, "additional_payer_notes": "100.00% of Medicare Rates" } ] } ] }, { "description": "BILIARY TRACT PROCEDURES EXCEPT ONLY CHOLECYSTECTOMY WITH OR WITHOUT C.D.E. WITH MCC", "code_information": [ { "code": "408", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 42762.0, "minimum": 25267.7, "maximum": 78554.7045, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "case rate", "standard_charge_dollar": 77400.07, "additional_payer_notes": "181.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medical Rental Network", "methodology": "case rate", "standard_charge_dollar": 77400.07, "additional_payer_notes": "181.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "case rate", "standard_charge_dollar": 34643.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "ALLY-ALIGN (FKA SPARTAN PLAN NJ, INC.)", "plan_name": "ALLY-ALIGN (FKA SPARTAN PLAN NJ, INC.)", "methodology": "case rate", "standard_charge_dollar": 44900.59, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Americhoice (UHC)", "plan_name": "UHC Medicare", "methodology": "case rate", "standard_charge_dollar": 34643.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Amerihealth", "plan_name": "Amerihealth Medicare", "methodology": "case rate", "standard_charge_dollar": 34643.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Commercial", "methodology": "case rate", "standard_charge_dollar": 52164.73 }, { "payer_name": "Clover Health", "plan_name": "Clover Medicare", "methodology": "case rate", "standard_charge_dollar": 34643.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Coventry", "plan_name": "Coventry Auto", "methodology": "case rate", "standard_charge_dollar": 72696.2, "additional_payer_notes": "170.00% of Medicare Rates" }, { "payer_name": "Coventry", "plan_name": "Coventry Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 72696.2, "additional_payer_notes": "170.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "case rate", "standard_charge_dollar": 55591.21, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Fairprice Healthcare Holdings", "plan_name": "Fairprice Healthcare Holdings", "methodology": "case rate", "standard_charge_dollar": 68419.95, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon Medicare", "methodology": "case rate", "standard_charge_dollar": 34643.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon NJ Health Medicaid", "methodology": "case rate", "standard_charge_dollar": 25267.7 }, { "payer_name": "Humana", "plan_name": "Humana Military Tricare", "methodology": "case rate", "standard_charge_dollar": 34209.98, "additional_payer_notes": "80.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 42762.47, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 76445.9 }, { "payer_name": "UBH", "plan_name": "UBH Medicare", "methodology": "case rate", "standard_charge_dollar": 34643.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC All Payer (02-01-2023 to 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 60101.75 }, { "payer_name": "UHC", "plan_name": "UHC Oxford (02-01-2023 to 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 52378.66 }, { "payer_name": "UHC - Adhoc", "plan_name": "UHC - Adhoc All Payer", "methodology": "case rate", "standard_charge_dollar": 63799.28 }, { "payer_name": "UHC - Adhoc", "plan_name": "UHC - Adhoc Oxford", "methodology": "case rate", "standard_charge_dollar": 53976.05 }, { "payer_name": "Wellcare", "plan_name": "Wellcare Insurance Exchange", "methodology": "case rate", "standard_charge_dollar": 57729.33, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "case rate", "standard_charge_dollar": 34643.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup Medicare", "methodology": "case rate", "standard_charge_dollar": 34643.8, "additional_payer_notes": "100.00% of Medicare Rates" } ] } ] }, { "description": "Hc Insert Indwel Tunneled Pleural Cath W Cuff", "code_information": [ { "code": "32550", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 500.0, "discounted_cash": 4232.0, "minimum": 95.45, "maximum": 500.0, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 500.0, "additional_payer_notes": "212.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medical Rental Network", "methodology": "fee schedule", "standard_charge_dollar": 500.0, "additional_payer_notes": "212.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 500.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "ALLY-ALIGN (FKA SPARTAN PLAN NJ, INC.)", "plan_name": "ALLY-ALIGN (FKA SPARTAN PLAN NJ, INC.)", "methodology": "fee schedule", "standard_charge_dollar": 500.0, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Americhoice (UHC)", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 500.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Amerihealth", "plan_name": "Amerihealth Medicare", "methodology": "fee schedule", "standard_charge_dollar": 500.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 500.0, "additional_payer_notes": "146.95% of Medicare Rates" }, { "payer_name": "Clover Health", "plan_name": "Clover Medicare", "methodology": "fee schedule", "standard_charge_dollar": 500.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Coventry", "plan_name": "Coventry Auto", "methodology": "fee schedule", "standard_charge_dollar": 500.0, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Coventry", "plan_name": "Coventry Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 500.0, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "fee schedule", "standard_charge_dollar": 500.0, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Fairprice Healthcare Holdings", "plan_name": "Fairprice Healthcare Holdings", "methodology": "fee schedule", "standard_charge_dollar": 500.0, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ HMO POS", "methodology": "fee schedule", "standard_charge_dollar": 500.0, "additional_payer_notes": "177.30% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ Indemnity", "methodology": "fee schedule", "standard_charge_dollar": 500.0, "additional_payer_notes": "177.30% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ PPO", "methodology": "fee schedule", "standard_charge_dollar": 500.0, "additional_payer_notes": "177.30% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon Medicare", "methodology": "fee schedule", "standard_charge_dollar": 500.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Military Tricare", "methodology": "fee schedule", "standard_charge_dollar": 500.0, "additional_payer_notes": "80.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 500.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 500.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC All Payer (02-01-2023 to 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 500.0 }, { "payer_name": "UHC", "plan_name": "UHC Oxford (02-01-2023 to 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 500.0 }, { "payer_name": "UHC - Adhoc", "plan_name": "UHC - Adhoc All Payer", "methodology": "case rate", "standard_charge_dollar": 500.0 }, { "payer_name": "UHC - Adhoc", "plan_name": "UHC - Adhoc Oxford", "methodology": "case rate", "standard_charge_dollar": 500.0 }, { "payer_name": "Wellcare", "plan_name": "Wellcare Insurance Exchange", "methodology": "fee schedule", "standard_charge_dollar": 500.0, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 500.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellchoice", "plan_name": "WELLCHOICE HMO of NJ (Empire) Commercial (HMO / HMO POS, PPO)", "methodology": "case rate", "standard_charge_dollar": 500.0 }, { "payer_name": "Wellchoice", "plan_name": "WELLCHOICE HMO of NJ (Empire) Commercial (Indemnity)", "methodology": "case rate", "standard_charge_dollar": 500.0 }, { "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup Medicare", "methodology": "fee schedule", "standard_charge_dollar": 500.0, "additional_payer_notes": "100.00% of Medicare Rates" } ] } ] }, { "description": "Hc Hla Class I Typing Low Resolution One Locus Each", "code_information": [ { "code": "81373", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 236.2, "discounted_cash": 127.0, "minimum": 45.0906, "maximum": 236.2, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 236.2, "additional_payer_notes": "212.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medical Rental Network", "methodology": "fee schedule", "standard_charge_dollar": 236.2, "additional_payer_notes": "212.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 127.43, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "ALLY-ALIGN (FKA SPARTAN PLAN NJ, INC.)", "plan_name": "ALLY-ALIGN (FKA SPARTAN PLAN NJ, INC.)", "methodology": "fee schedule", "standard_charge_dollar": 133.8, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Americhoice (UHC)", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 127.43, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Amerihealth", "plan_name": "Amerihealth Medicare", "methodology": "fee schedule", "standard_charge_dollar": 127.43, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 184.77, "additional_payer_notes": "A Indicator - 155.00% of Medicare Rates" }, { "payer_name": "Clover Health", "plan_name": "Clover Medicare", "methodology": "fee schedule", "standard_charge_dollar": 127.43, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Coventry", "plan_name": "Coventry Auto", "methodology": "fee schedule", "standard_charge_dollar": 236.2, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Coventry", "plan_name": "Coventry Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 236.2, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "fee schedule", "standard_charge_dollar": 178.4, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Fairprice Healthcare Holdings", "plan_name": "Fairprice Healthcare Holdings", "methodology": "fee schedule", "standard_charge_dollar": 152.92, "additional_payer_notes": "Laboratory - 120.00% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ HMO POS", "methodology": "fee schedule", "standard_charge_dollar": 166.76, "additional_payer_notes": "177.30% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ Indemnity", "methodology": "fee schedule", "standard_charge_dollar": 166.76, "additional_payer_notes": "177.30% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ PPO", "methodology": "fee schedule", "standard_charge_dollar": 166.76, "additional_payer_notes": "177.30% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon Medicare", "methodology": "fee schedule", "standard_charge_dollar": 127.43, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Military Tricare", "methodology": "fee schedule", "standard_charge_dollar": 101.94, "additional_payer_notes": "80.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 127.43, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 127.43, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC All Payer (02-01-2023 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 76.46 }, { "payer_name": "UHC", "plan_name": "UHC Medicaid (02/01/2023 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 101.94 }, { "payer_name": "UHC", "plan_name": "UHC Oxford (02-01-2023 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 76.46 }, { "payer_name": "UHC - Adhoc", "plan_name": "UHC - Adhoc All Payer", "methodology": "fee schedule", "standard_charge_dollar": 127.43 }, { "payer_name": "UHC - Adhoc", "plan_name": "UHC - Adhoc Oxford", "methodology": "fee schedule", "standard_charge_dollar": 127.43 }, { "payer_name": "Wellcare", "plan_name": "Wellcare Insurance Exchange", "methodology": "fee schedule", "standard_charge_dollar": 172.03, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 127.43, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup Medicare", "methodology": "fee schedule", "standard_charge_dollar": 127.43, "additional_payer_notes": "100.00% of Medicare Rates" } ] } ] }, { "description": "BIOPSY OF VAGINA", "code_information": [ { "code": "57100", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 10260.0, "discounted_cash": 1088.0, "minimum": 871.096, "maximum": 8208.0, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 2308.4, "additional_payer_notes": "212.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medical Rental Network", "methodology": "fee schedule", "standard_charge_dollar": 2308.4, "additional_payer_notes": "212.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1088.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "ALLY-ALIGN (FKA SPARTAN PLAN NJ, INC.)", "plan_name": "ALLY-ALIGN (FKA SPARTAN PLAN NJ, INC.)", "methodology": "fee schedule", "standard_charge_dollar": 1143.31, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Americhoice (UHC)", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1088.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Amerihealth", "plan_name": "Amerihealth Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1088.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 1600.09, "additional_payer_notes": "146.95% of Medicare Rates" }, { "payer_name": "Clover Health", "plan_name": "Clover Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1088.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Coventry", "plan_name": "Coventry Auto", "methodology": "fee schedule", "standard_charge_dollar": 2177.74, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Coventry", "plan_name": "Coventry Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 2177.74, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "fee schedule", "standard_charge_dollar": 1524.42, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Fairprice Healthcare Holdings", "plan_name": "Fairprice Healthcare Holdings", "methodology": "fee schedule", "standard_charge_dollar": 1742.19, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ HMO POS", "methodology": "fee schedule", "standard_charge_dollar": 1930.57, "additional_payer_notes": "177.30% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ Indemnity", "methodology": "fee schedule", "standard_charge_dollar": 1930.57, "additional_payer_notes": "177.30% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ PPO", "methodology": "fee schedule", "standard_charge_dollar": 1930.57, "additional_payer_notes": "177.30% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1088.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Military Tricare", "methodology": "fee schedule", "standard_charge_dollar": 871.1, "additional_payer_notes": "80.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1088.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 1088.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC All Payer (02-01-2023 to 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 3147.0 }, { "payer_name": "UHC", "plan_name": "UHC Oxford (02-01-2023 to 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 2297.0 }, { "payer_name": "UHC - Adhoc", "plan_name": "UHC - Adhoc All Payer", "methodology": "case rate", "standard_charge_dollar": 3341.0 }, { "payer_name": "UHC - Adhoc", "plan_name": "UHC - Adhoc Oxford", "methodology": "case rate", "standard_charge_dollar": 2367.0 }, { "payer_name": "Wellcare", "plan_name": "Wellcare Insurance Exchange", "methodology": "fee schedule", "standard_charge_dollar": 1469.97, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1088.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellchoice", "plan_name": "WELLCHOICE HMO of NJ (Empire) Commercial (HMO / HMO POS, PPO)", "methodology": "case rate", "standard_charge_dollar": 1715.0 }, { "payer_name": "Wellchoice", "plan_name": "WELLCHOICE HMO of NJ (Empire) Commercial (Indemnity)", "methodology": "case rate", "standard_charge_dollar": 1978.0 }, { "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1088.87, "additional_payer_notes": "100.00% of Medicare Rates" } ] } ] }, { "description": "Hc Evaluation Of Speech Fluency (Stutter Clutter), 30 Min", "code_information": [ { "code": "92521", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 515.35, "discounted_cash": 147.0, "minimum": 98.3803, "maximum": 438.0475, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 312.28, "additional_payer_notes": "212.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medical Rental Network", "methodology": "fee schedule", "standard_charge_dollar": 312.28, "additional_payer_notes": "212.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 147.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "ALLY-ALIGN (FKA SPARTAN PLAN NJ, INC.)", "plan_name": "ALLY-ALIGN (FKA SPARTAN PLAN NJ, INC.)", "methodology": "fee schedule", "standard_charge_dollar": 154.67, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Americhoice (UHC)", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 147.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Amerihealth", "plan_name": "Amerihealth Medicare", "methodology": "fee schedule", "standard_charge_dollar": 147.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 158.0, "additional_payer_notes": "A Indicator - 155.00% of Medicare Rates" }, { "payer_name": "Clover Health", "plan_name": "Clover Medicare", "methodology": "fee schedule", "standard_charge_dollar": 147.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Coventry", "plan_name": "Coventry Auto", "methodology": "fee schedule", "standard_charge_dollar": 294.6, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Coventry", "plan_name": "Coventry Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 294.6, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "fee schedule", "standard_charge_dollar": 206.22, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Fairprice Healthcare Holdings", "plan_name": "Fairprice Healthcare Holdings", "methodology": "fee schedule", "standard_charge_dollar": 235.68 }, { "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ HMO POS", "methodology": "fee schedule", "standard_charge_dollar": 363.84, "additional_payer_notes": "177.30% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ Indemnity", "methodology": "fee schedule", "standard_charge_dollar": 363.84, "additional_payer_notes": "177.30% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ PPO", "methodology": "fee schedule", "standard_charge_dollar": 363.84, "additional_payer_notes": "177.30% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon Medicare", "methodology": "fee schedule", "standard_charge_dollar": 147.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Military Tricare", "methodology": "fee schedule", "standard_charge_dollar": 117.84, "additional_payer_notes": "80.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 147.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 147.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC All Payer (02-01-2023 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 407.0 }, { "payer_name": "UHC", "plan_name": "UHC Oxford (02-01-2023 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 357.0 }, { "payer_name": "UHC - Adhoc", "plan_name": "UHC - Adhoc All Payer", "methodology": "fee schedule", "standard_charge_dollar": 432.0 }, { "payer_name": "UHC - Adhoc", "plan_name": "UHC - Adhoc Oxford", "methodology": "fee schedule", "standard_charge_dollar": 368.0 }, { "payer_name": "Wellcare", "plan_name": "Wellcare Insurance Exchange", "methodology": "fee schedule", "standard_charge_dollar": 198.86, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 147.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup Medicare", "methodology": "fee schedule", "standard_charge_dollar": 147.3, "additional_payer_notes": "100.00% of Medicare Rates" } ] } ] }, { "description": "Hc Place Neprostomy Cath, Perq W Img", "code_information": [ { "code": "50432", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 8698.75, "discounted_cash": 2471.0, "minimum": 1660.5914, "maximum": 6959.0, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 5239.07, "additional_payer_notes": "212.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medical Rental Network", "methodology": "fee schedule", "standard_charge_dollar": 5239.07, "additional_payer_notes": "212.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2471.26, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "ALLY-ALIGN (FKA SPARTAN PLAN NJ, INC.)", "plan_name": "ALLY-ALIGN (FKA SPARTAN PLAN NJ, INC.)", "methodology": "fee schedule", "standard_charge_dollar": 2594.82, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Americhoice (UHC)", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2471.26, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Amerihealth", "plan_name": "Amerihealth Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2471.26, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 3631.52, "additional_payer_notes": "146.95% of Medicare Rates" }, { "payer_name": "Clover Health", "plan_name": "Clover Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2471.26, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Coventry", "plan_name": "Coventry Auto", "methodology": "fee schedule", "standard_charge_dollar": 4942.52, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Coventry", "plan_name": "Coventry Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 4942.52, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "fee schedule", "standard_charge_dollar": 3459.76, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Fairprice Healthcare Holdings", "plan_name": "Fairprice Healthcare Holdings", "methodology": "fee schedule", "standard_charge_dollar": 3954.02, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ HMO POS", "methodology": "fee schedule", "standard_charge_dollar": 4381.54, "additional_payer_notes": "177.30% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ Indemnity", "methodology": "fee schedule", "standard_charge_dollar": 4381.54, "additional_payer_notes": "177.30% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ PPO", "methodology": "fee schedule", "standard_charge_dollar": 4381.54, "additional_payer_notes": "177.30% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2471.26, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Military Tricare", "methodology": "fee schedule", "standard_charge_dollar": 1977.01, "additional_payer_notes": "80.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2471.26, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 2471.26, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC All Payer (02-01-2023 to 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 4415.0 }, { "payer_name": "UHC", "plan_name": "UHC Oxford (02-01-2023 to 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 4020.0 }, { "payer_name": "UHC - Adhoc", "plan_name": "UHC - Adhoc All Payer", "methodology": "case rate", "standard_charge_dollar": 4687.0 }, { "payer_name": "UHC - Adhoc", "plan_name": "UHC - Adhoc Oxford", "methodology": "case rate", "standard_charge_dollar": 4143.0 }, { "payer_name": "Wellcare", "plan_name": "Wellcare Insurance Exchange", "methodology": "fee schedule", "standard_charge_dollar": 3336.2, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2471.26, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellchoice", "plan_name": "WELLCHOICE HMO of NJ (Empire) Commercial (HMO / HMO POS, PPO)", "methodology": "case rate", "standard_charge_dollar": 1715.0 }, { "payer_name": "Wellchoice", "plan_name": "WELLCHOICE HMO of NJ (Empire) Commercial (Indemnity)", "methodology": "case rate", "standard_charge_dollar": 1978.0 }, { "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2471.26, "additional_payer_notes": "100.00% of Medicare Rates" } ] } ] }, { "description": "Hc Ro Respirator Motion Mgmt Simulation", "code_information": [ { "code": "77293", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 2612.27, "minimum": 167.0, "maximum": 2089.816, "payers_information": [ { "payer_name": "UHC", "plan_name": "UHC All Payer (02-01-2023 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 1260.0 }, { "payer_name": "UHC", "plan_name": "UHC Oxford (02-01-2023 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 1103.0 }, { "payer_name": "UHC - Adhoc", "plan_name": "UHC - Adhoc All Payer", "methodology": "fee schedule", "standard_charge_dollar": 1337.0 }, { "payer_name": "UHC - Adhoc", "plan_name": "UHC - Adhoc Oxford", "methodology": "fee schedule", "standard_charge_dollar": 1137.0 }, { "payer_name": "Wellchoice", "plan_name": "WELLCHOICE HMO of NJ (Empire) Commercial (HMO / HMO POS, PPO)", "methodology": "case rate", "standard_charge_dollar": 167.0 }, { "payer_name": "Wellchoice", "plan_name": "WELLCHOICE HMO of NJ (Empire) Commercial (Indemnity)", "methodology": "case rate", "standard_charge_dollar": 202.0 } ] } ] }, { "description": "CHRONIC OBSTRUCTIVE PULMONARY DISEASE WITH CC", "code_information": [ { "code": "191", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 11298.0, "minimum": 5706.7, "maximum": 20450.8642, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "case rate", "standard_charge_dollar": 20450.86, "additional_payer_notes": "181.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medical Rental Network", "methodology": "case rate", "standard_charge_dollar": 20450.86, "additional_payer_notes": "181.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "case rate", "standard_charge_dollar": 9379.36, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "ALLY-ALIGN (FKA SPARTAN PLAN NJ, INC.)", "plan_name": "ALLY-ALIGN (FKA SPARTAN PLAN NJ, INC.)", "methodology": "case rate", "standard_charge_dollar": 11863.76, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Americhoice (UHC)", "plan_name": "UHC Medicare", "methodology": "case rate", "standard_charge_dollar": 9379.36, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Amerihealth", "plan_name": "Amerihealth Medicare", "methodology": "case rate", "standard_charge_dollar": 9379.36, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Commercial", "methodology": "case rate", "standard_charge_dollar": 12333.09 }, { "payer_name": "Clover Health", "plan_name": "Clover Medicare", "methodology": "case rate", "standard_charge_dollar": 9379.36, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Coventry", "plan_name": "Coventry Auto", "methodology": "case rate", "standard_charge_dollar": 19207.99, "additional_payer_notes": "170.00% of Medicare Rates" }, { "payer_name": "Coventry", "plan_name": "Coventry Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 19207.99, "additional_payer_notes": "170.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "case rate", "standard_charge_dollar": 14688.47, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Fairprice Healthcare Holdings", "plan_name": "Fairprice Healthcare Holdings", "methodology": "case rate", "standard_charge_dollar": 18078.11, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon Medicare", "methodology": "case rate", "standard_charge_dollar": 9379.36, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon NJ Health Medicaid", "methodology": "case rate", "standard_charge_dollar": 5706.7 }, { "payer_name": "Humana", "plan_name": "Humana Military Tricare", "methodology": "case rate", "standard_charge_dollar": 9039.06, "additional_payer_notes": "80.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 11298.82, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 10530.3 }, { "payer_name": "UBH", "plan_name": "UBH Medicare", "methodology": "case rate", "standard_charge_dollar": 9379.36, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC All Payer (02-01-2023 to 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 14209.61 }, { "payer_name": "UHC", "plan_name": "UHC Oxford (02-01-2023 to 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 12383.67 }, { "payer_name": "UHC - Adhoc", "plan_name": "UHC - Adhoc All Payer", "methodology": "case rate", "standard_charge_dollar": 15083.8 }, { "payer_name": "UHC - Adhoc", "plan_name": "UHC - Adhoc Oxford", "methodology": "case rate", "standard_charge_dollar": 12761.33 }, { "payer_name": "Wellcare", "plan_name": "Wellcare Insurance Exchange", "methodology": "case rate", "standard_charge_dollar": 15253.41, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "case rate", "standard_charge_dollar": 9379.36, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup Medicare", "methodology": "case rate", "standard_charge_dollar": 9379.36, "additional_payer_notes": "100.00% of Medicare Rates" } ] } ] }, { "description": "Hc Office/Outpatient Established Low Mdm 20-29 Min - 99213 - 76100008", "code_information": [ { "code": "99213", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 542.65, "minimum": 67.86, "maximum": 461.2525, "payers_information": [ { "payer_name": "Amerihealth", "plan_name": "Amerihealth HMO", "methodology": "fee schedule", "standard_charge_dollar": 67.86 }, { "payer_name": "Amerihealth", "plan_name": "Amerihealth Medicare", "methodology": "fee schedule", "standard_charge_dollar": 67.86, "additional_payer_notes": "100.00% of Medicare Rates" } ] } ] }, { "description": "Hc Hepatitis Delta Ag Eia", "code_information": [ { "code": "87380", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 203.0, "discounted_cash": 18.0, "minimum": 11.02, "maximum": 172.55, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 38.92, "additional_payer_notes": "212.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medical Rental Network", "methodology": "fee schedule", "standard_charge_dollar": 38.92, "additional_payer_notes": "212.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 18.36, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "ALLY-ALIGN (FKA SPARTAN PLAN NJ, INC.)", "plan_name": "ALLY-ALIGN (FKA SPARTAN PLAN NJ, INC.)", "methodology": "fee schedule", "standard_charge_dollar": 19.28, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Americhoice (UHC)", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 18.36, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Amerihealth", "plan_name": "Amerihealth Medicare", "methodology": "fee schedule", "standard_charge_dollar": 18.36, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 26.62, "additional_payer_notes": "Laboratory - 145.00% of Medicare Rates" }, { "payer_name": "Clover Health", "plan_name": "Clover Medicare", "methodology": "fee schedule", "standard_charge_dollar": 18.36, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Coventry", "plan_name": "Coventry Auto", "methodology": "fee schedule", "standard_charge_dollar": 36.72, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Coventry", "plan_name": "Coventry Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 36.72, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "fee schedule", "standard_charge_dollar": 25.7, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Fairprice Healthcare Holdings", "plan_name": "Fairprice Healthcare Holdings", "methodology": "fee schedule", "standard_charge_dollar": 22.03, "additional_payer_notes": "Laboratory - 120.00% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ HMO POS", "methodology": "fee schedule", "standard_charge_dollar": 143.32, "additional_payer_notes": "177.30% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ Indemnity", "methodology": "fee schedule", "standard_charge_dollar": 143.32, "additional_payer_notes": "177.30% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ PPO", "methodology": "fee schedule", "standard_charge_dollar": 143.32, "additional_payer_notes": "177.30% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon Medicare", "methodology": "fee schedule", "standard_charge_dollar": 18.36, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Military Tricare", "methodology": "fee schedule", "standard_charge_dollar": 14.69, "additional_payer_notes": "80.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 18.36, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 18.36, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC All Payer (02-01-2023 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 11.02 }, { "payer_name": "UHC", "plan_name": "UHC Medicaid (02/01/2023 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 14.69 }, { "payer_name": "UHC", "plan_name": "UHC Oxford (02-01-2023 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 11.02 }, { "payer_name": "UHC - Adhoc", "plan_name": "UHC - Adhoc All Payer", "methodology": "fee schedule", "standard_charge_dollar": 18.36 }, { "payer_name": "UHC - Adhoc", "plan_name": "UHC - Adhoc Oxford", "methodology": "fee schedule", "standard_charge_dollar": 18.36 }, { "payer_name": "Wellcare", "plan_name": "Wellcare Insurance Exchange", "methodology": "fee schedule", "standard_charge_dollar": 24.79, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 18.36, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup Medicare", "methodology": "fee schedule", "standard_charge_dollar": 18.36, "additional_payer_notes": "100.00% of Medicare Rates" } ] } ] }, { "description": "Cystouretero W/Lithotripsy", "code_information": [ { "code": "52353", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 20557.5, "discounted_cash": 6338.0, "minimum": 1715.0, "maximum": 16446.0, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 13438.13, "additional_payer_notes": "212.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medical Rental Network", "methodology": "fee schedule", "standard_charge_dollar": 13438.13, "additional_payer_notes": "212.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 6338.74, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "ALLY-ALIGN (FKA SPARTAN PLAN NJ, INC.)", "plan_name": "ALLY-ALIGN (FKA SPARTAN PLAN NJ, INC.)", "methodology": "fee schedule", "standard_charge_dollar": 6655.68, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Americhoice (UHC)", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 6338.74, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Amerihealth", "plan_name": "Amerihealth Medicare", "methodology": "fee schedule", "standard_charge_dollar": 6338.74, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 9314.78, "additional_payer_notes": "146.95% of Medicare Rates" }, { "payer_name": "Clover Health", "plan_name": "Clover Medicare", "methodology": "fee schedule", "standard_charge_dollar": 6338.74, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Coventry", "plan_name": "Coventry Auto", "methodology": "fee schedule", "standard_charge_dollar": 12677.48, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Coventry", "plan_name": "Coventry Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 12677.48, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "fee schedule", "standard_charge_dollar": 8874.24, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Fairprice Healthcare Holdings", "plan_name": "Fairprice Healthcare Holdings", "methodology": "fee schedule", "standard_charge_dollar": 10141.98, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ HMO POS", "methodology": "fee schedule", "standard_charge_dollar": 11238.59, "additional_payer_notes": "177.30% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ Indemnity", "methodology": "fee schedule", "standard_charge_dollar": 11238.59, "additional_payer_notes": "177.30% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ PPO", "methodology": "fee schedule", "standard_charge_dollar": 11238.59, "additional_payer_notes": "177.30% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon Medicare", "methodology": "fee schedule", "standard_charge_dollar": 6338.74, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Military Tricare", "methodology": "fee schedule", "standard_charge_dollar": 5070.99, "additional_payer_notes": "80.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 6338.74, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 6338.74, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC All Payer (02-01-2023 to 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 5667.0 }, { "payer_name": "UHC", "plan_name": "UHC Oxford (02-01-2023 to 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 5169.0 }, { "payer_name": "UHC - Adhoc", "plan_name": "UHC - Adhoc All Payer", "methodology": "case rate", "standard_charge_dollar": 6016.0 }, { "payer_name": "UHC - Adhoc", "plan_name": "UHC - Adhoc Oxford", "methodology": "case rate", "standard_charge_dollar": 5327.0 }, { "payer_name": "Wellcare", "plan_name": "Wellcare Insurance Exchange", "methodology": "fee schedule", "standard_charge_dollar": 8557.3, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 6338.74, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellchoice", "plan_name": "WELLCHOICE HMO of NJ (Empire) Commercial (HMO / HMO POS, PPO)", "methodology": "case rate", "standard_charge_dollar": 1715.0 }, { "payer_name": "Wellchoice", "plan_name": "WELLCHOICE HMO of NJ (Empire) Commercial (Indemnity)", "methodology": "case rate", "standard_charge_dollar": 1978.0 }, { "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup Medicare", "methodology": "fee schedule", "standard_charge_dollar": 6338.74, "additional_payer_notes": "100.00% of Medicare Rates" } ] } ] }, { "description": "OSTEOMYELITIS WITH CC", "code_information": [ { "code": "540", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 16537.0, "minimum": 8098.28, "maximum": 29932.6397, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "case rate", "standard_charge_dollar": 29932.64, "additional_payer_notes": "181.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medical Rental Network", "methodology": "case rate", "standard_charge_dollar": 29932.64, "additional_payer_notes": "181.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "case rate", "standard_charge_dollar": 13585.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "ALLY-ALIGN (FKA SPARTAN PLAN NJ, INC.)", "plan_name": "ALLY-ALIGN (FKA SPARTAN PLAN NJ, INC.)", "methodology": "case rate", "standard_charge_dollar": 17364.24, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Americhoice (UHC)", "plan_name": "UHC Medicare", "methodology": "case rate", "standard_charge_dollar": 13585.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Amerihealth", "plan_name": "Amerihealth Medicare", "methodology": "case rate", "standard_charge_dollar": 13585.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Commercial", "methodology": "case rate", "standard_charge_dollar": 18964.87 }, { "payer_name": "Clover Health", "plan_name": "Clover Medicare", "methodology": "case rate", "standard_charge_dollar": 13585.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Coventry", "plan_name": "Coventry Auto", "methodology": "case rate", "standard_charge_dollar": 28113.53, "additional_payer_notes": "170.00% of Medicare Rates" }, { "payer_name": "Coventry", "plan_name": "Coventry Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 28113.53, "additional_payer_notes": "170.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "case rate", "standard_charge_dollar": 21498.58, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Fairprice Healthcare Holdings", "plan_name": "Fairprice Healthcare Holdings", "methodology": "case rate", "standard_charge_dollar": 26459.79, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon Medicare", "methodology": "case rate", "standard_charge_dollar": 13585.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon NJ Health Medicaid", "methodology": "case rate", "standard_charge_dollar": 8098.28 }, { "payer_name": "Humana", "plan_name": "Humana Military Tricare", "methodology": "case rate", "standard_charge_dollar": 13229.9, "additional_payer_notes": "80.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 16537.37, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 11860.6 }, { "payer_name": "UBH", "plan_name": "UBH Medicare", "methodology": "case rate", "standard_charge_dollar": 13585.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC All Payer (02-01-2023 to 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 21850.43 }, { "payer_name": "UHC", "plan_name": "UHC Oxford (02-01-2023 to 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 19042.65 }, { "payer_name": "UHC - Adhoc", "plan_name": "UHC - Adhoc All Payer", "methodology": "case rate", "standard_charge_dollar": 23194.7 }, { "payer_name": "UHC - Adhoc", "plan_name": "UHC - Adhoc Oxford", "methodology": "case rate", "standard_charge_dollar": 19623.39 }, { "payer_name": "Wellcare", "plan_name": "Wellcare Insurance Exchange", "methodology": "case rate", "standard_charge_dollar": 22325.45, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "case rate", "standard_charge_dollar": 13585.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup Medicare", "methodology": "case rate", "standard_charge_dollar": 13585.8, "additional_payer_notes": "100.00% of Medicare Rates" } ] } ] }, { "description": "ALCOHOL ABUSE & DEPENDENCE - SOI : 3", "code_information": [ { "code": "7753", "type": "APR-DRG" } ], "standard_charges": [ { "setting": "inpatient", "minimum": 11184.93, "maximum": 12303.43, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Better Health - Medi Medi", "methodology": "case rate", "standard_charge_dollar": 12303.43, "additional_payer_notes": "110% of State Medicaid Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Better Health Medicaid", "methodology": "case rate", "standard_charge_dollar": 12303.43, "additional_payer_notes": "110% of State Medicaid Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "case rate", "standard_charge_dollar": 11184.93, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "UBH", "plan_name": "UBH Medicaid", "methodology": "case rate", "standard_charge_dollar": 11184.93, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicaid (02/01/2023 to 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 11408.63, "additional_payer_notes": "102% of State Medicaid Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicaid", "methodology": "case rate", "standard_charge_dollar": 11184.93, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup Medicaid", "methodology": "case rate", "standard_charge_dollar": 11184.93, "additional_payer_notes": "100% of State Medicaid Rates" } ] } ] }, { "description": "Hc Hemodialysis W Sing Eval (Crrt)", "code_information": [ { "code": "90935", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 3200.15, "discounted_cash": 811.0, "minimum": 547.6463, "maximum": 2720.1275, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 1720.08, "additional_payer_notes": "212.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medical Rental Network", "methodology": "fee schedule", "standard_charge_dollar": 1720.08, "additional_payer_notes": "212.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 811.36, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "ALLY-ALIGN (FKA SPARTAN PLAN NJ, INC.)", "plan_name": "ALLY-ALIGN (FKA SPARTAN PLAN NJ, INC.)", "methodology": "fee schedule", "standard_charge_dollar": 851.93, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Americhoice (UHC)", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 811.36, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Amerihealth", "plan_name": "Amerihealth Medicare", "methodology": "fee schedule", "standard_charge_dollar": 811.36, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 840.0, "additional_payer_notes": "146.95% of Medicare Rates" }, { "payer_name": "Clover Health", "plan_name": "Clover Medicare", "methodology": "fee schedule", "standard_charge_dollar": 811.36, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Coventry", "plan_name": "Coventry Auto", "methodology": "fee schedule", "standard_charge_dollar": 1622.72, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Coventry", "plan_name": "Coventry Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 1622.72, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "fee schedule", "standard_charge_dollar": 1135.9, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Fairprice Healthcare Holdings", "plan_name": "Fairprice Healthcare Holdings", "methodology": "fee schedule", "standard_charge_dollar": 1298.18, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ HMO POS", "methodology": "fee schedule", "standard_charge_dollar": 1438.54, "additional_payer_notes": "177.30% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ Indemnity", "methodology": "fee schedule", "standard_charge_dollar": 1438.54, "additional_payer_notes": "177.30% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ PPO", "methodology": "fee schedule", "standard_charge_dollar": 1438.54, "additional_payer_notes": "177.30% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon Medicare", "methodology": "fee schedule", "standard_charge_dollar": 811.36, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Military Tricare", "methodology": "fee schedule", "standard_charge_dollar": 649.09, "additional_payer_notes": "80.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 811.36, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 811.36, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicaid (02/01/2023 to 12-31-2026)", "methodology": "percent of total billed charges", "standard_charge_percentage": 19.47, "median_amount": 824.03, "10th_percentile": 824.03, "90th_percentile": 824.03, "count": "1 through 10" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Insurance Exchange", "methodology": "fee schedule", "standard_charge_dollar": 1095.34, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 811.36, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup Medicaid", "methodology": "percent of total billed charges", "standard_charge_percentage": 19.09, "median_amount": 824.03, "10th_percentile": 824.03, "90th_percentile": 824.03, "count": "1 through 10" }, { "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup Medicare", "methodology": "fee schedule", "standard_charge_dollar": 811.36, "additional_payer_notes": "100.00% of Medicare Rates" } ] } ] }, { "description": "PELVIC EVISCERATION, RADICAL HYSTERECTOMY & OTHER RADICAL GYN PROCS - SOI : 3", "code_information": [ { "code": "5103", "type": "APR-DRG" } ], "standard_charges": [ { "setting": "inpatient", "minimum": 31207.39, "maximum": 34328.13, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Better Health - Medi Medi", "methodology": "case rate", "standard_charge_dollar": 34328.13, "additional_payer_notes": "110% of State Medicaid Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Better Health Medicaid", "methodology": "case rate", "standard_charge_dollar": 34328.13, "additional_payer_notes": "110% of State Medicaid Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "case rate", "standard_charge_dollar": 31207.39, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "UBH", "plan_name": "UBH Medicaid", "methodology": "case rate", "standard_charge_dollar": 31207.39, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicaid (02/01/2023 to 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 31831.54, "additional_payer_notes": "102% of State Medicaid Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicaid", "methodology": "case rate", "standard_charge_dollar": 31207.39, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup Medicaid", "methodology": "case rate", "standard_charge_dollar": 31207.39, "additional_payer_notes": "100% of State Medicaid Rates" } ] } ] }, { "description": "Hc Complement, Total (Ch50)", "code_information": [ { "code": "86162", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 140.0, "discounted_cash": 20.0, "minimum": 12.19, "maximum": 119.0, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 43.08, "additional_payer_notes": "212.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medical Rental Network", "methodology": "fee schedule", "standard_charge_dollar": 43.08, "additional_payer_notes": "212.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 20.32, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "ALLY-ALIGN (FKA SPARTAN PLAN NJ, INC.)", "plan_name": "ALLY-ALIGN (FKA SPARTAN PLAN NJ, INC.)", "methodology": "fee schedule", "standard_charge_dollar": 21.34, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Americhoice (UHC)", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 20.32, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Amerihealth", "plan_name": "Amerihealth Medicare", "methodology": "fee schedule", "standard_charge_dollar": 20.32, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 29.46, "additional_payer_notes": "Laboratory - 145.00% of Medicare Rates" }, { "payer_name": "Clover Health", "plan_name": "Clover Medicare", "methodology": "fee schedule", "standard_charge_dollar": 20.32, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Coventry", "plan_name": "Coventry Auto", "methodology": "fee schedule", "standard_charge_dollar": 40.64, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Coventry", "plan_name": "Coventry Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 40.64, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "fee schedule", "standard_charge_dollar": 28.45, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Fairprice Healthcare Holdings", "plan_name": "Fairprice Healthcare Holdings", "methodology": "fee schedule", "standard_charge_dollar": 24.38, "additional_payer_notes": "Laboratory - 120.00% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ HMO POS", "methodology": "fee schedule", "standard_charge_dollar": 98.84, "additional_payer_notes": "177.30% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ Indemnity", "methodology": "fee schedule", "standard_charge_dollar": 98.84, "additional_payer_notes": "177.30% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ PPO", "methodology": "fee schedule", "standard_charge_dollar": 98.84, "additional_payer_notes": "177.30% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon Medicare", "methodology": "fee schedule", "standard_charge_dollar": 20.32, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Military Tricare", "methodology": "fee schedule", "standard_charge_dollar": 16.26, "additional_payer_notes": "80.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 20.32, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 20.32, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC All Payer (02-01-2023 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 12.19 }, { "payer_name": "UHC", "plan_name": "UHC Medicaid (02/01/2023 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 16.26 }, { "payer_name": "UHC", "plan_name": "UHC Oxford (02-01-2023 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 12.19 }, { "payer_name": "UHC - Adhoc", "plan_name": "UHC - Adhoc All Payer", "methodology": "fee schedule", "standard_charge_dollar": 20.32 }, { "payer_name": "UHC - Adhoc", "plan_name": "UHC - Adhoc Oxford", "methodology": "fee schedule", "standard_charge_dollar": 20.32 }, { "payer_name": "Wellcare", "plan_name": "Wellcare Insurance Exchange", "methodology": "fee schedule", "standard_charge_dollar": 27.43, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 20.32, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup Medicare", "methodology": "fee schedule", "standard_charge_dollar": 20.32, "additional_payer_notes": "100.00% of Medicare Rates" } ] } ] }, { "description": "Excision Of Anal Lesion(S)", "code_information": [ { "code": "46922", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 15390.0, "discounted_cash": 3281.0, "minimum": 1715.0, "maximum": 12312.0, "payers_information": [ { "payer_name": "Coventry", "plan_name": "Coventry Auto", "methodology": "fee schedule", "standard_charge_dollar": 6562.78, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Coventry", "plan_name": "Coventry Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 6562.78, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "fee schedule", "standard_charge_dollar": 4593.95, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Fairprice Healthcare Holdings", "plan_name": "Fairprice Healthcare Holdings", "methodology": "fee schedule", "standard_charge_dollar": 5250.22, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ HMO POS", "methodology": "fee schedule", "standard_charge_dollar": 5817.9, "additional_payer_notes": "177.30% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ Indemnity", "methodology": "fee schedule", "standard_charge_dollar": 5817.9, "additional_payer_notes": "177.30% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ PPO", "methodology": "fee schedule", "standard_charge_dollar": 5817.9, "additional_payer_notes": "177.30% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3281.39, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Military Tricare", "methodology": "fee schedule", "standard_charge_dollar": 2625.11, "additional_payer_notes": "80.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3281.39, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 3281.39, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC All Payer (02-01-2023 to 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 4415.0 }, { "payer_name": "UHC", "plan_name": "UHC Oxford (02-01-2023 to 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 4020.0 }, { "payer_name": "UHC - Adhoc", "plan_name": "UHC - Adhoc All Payer", "methodology": "case rate", "standard_charge_dollar": 4687.0 }, { "payer_name": "UHC - Adhoc", "plan_name": "UHC - Adhoc Oxford", "methodology": "case rate", "standard_charge_dollar": 4143.0 }, { "payer_name": "Wellcare", "plan_name": "Wellcare Insurance Exchange", "methodology": "fee schedule", "standard_charge_dollar": 4429.88, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3281.39, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellchoice", "plan_name": "WELLCHOICE HMO of NJ (Empire) Commercial (HMO / HMO POS, PPO)", "methodology": "case rate", "standard_charge_dollar": 1715.0 }, { "payer_name": "Wellchoice", "plan_name": "WELLCHOICE HMO of NJ (Empire) Commercial (Indemnity)", "methodology": "case rate", "standard_charge_dollar": 1978.0 }, { "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3281.39, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 6956.55, "additional_payer_notes": "212.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medical Rental Network", "methodology": "fee schedule", "standard_charge_dollar": 6956.55, "additional_payer_notes": "212.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3281.39, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "ALLY-ALIGN (FKA SPARTAN PLAN NJ, INC.)", "plan_name": "ALLY-ALIGN (FKA SPARTAN PLAN NJ, INC.)", "methodology": "fee schedule", "standard_charge_dollar": 3445.46, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Americhoice (UHC)", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3281.39, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Amerihealth", "plan_name": "Amerihealth Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3281.39, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 4822.0, "additional_payer_notes": "146.95% of Medicare Rates" }, { "payer_name": "Clover Health", "plan_name": "Clover Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3281.39, "additional_payer_notes": "100.00% of Medicare Rates" } ] } ] }, { "description": "Inj Paravert F Jnt L/S 1 Lev", "code_information": [ { "code": "64493", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 14532.0, "discounted_cash": 1045.0, "minimum": 836.496, "maximum": 11625.6, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 2216.71, "additional_payer_notes": "212.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medical Rental Network", "methodology": "fee schedule", "standard_charge_dollar": 2216.71, "additional_payer_notes": "212.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1045.62, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "ALLY-ALIGN (FKA SPARTAN PLAN NJ, INC.)", "plan_name": "ALLY-ALIGN (FKA SPARTAN PLAN NJ, INC.)", "methodology": "fee schedule", "standard_charge_dollar": 1097.9, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Americhoice (UHC)", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1045.62, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Amerihealth", "plan_name": "Amerihealth Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1045.62, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 1536.54, "additional_payer_notes": "146.95% of Medicare Rates" }, { "payer_name": "Clover Health", "plan_name": "Clover Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1045.62, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Coventry", "plan_name": "Coventry Auto", "methodology": "fee schedule", "standard_charge_dollar": 2091.24, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Coventry", "plan_name": "Coventry Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 2091.24, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "fee schedule", "standard_charge_dollar": 1463.87, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Fairprice Healthcare Holdings", "plan_name": "Fairprice Healthcare Holdings", "methodology": "fee schedule", "standard_charge_dollar": 1672.99, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ HMO POS", "methodology": "fee schedule", "standard_charge_dollar": 1853.88, "additional_payer_notes": "177.30% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ Indemnity", "methodology": "fee schedule", "standard_charge_dollar": 1853.88, "additional_payer_notes": "177.30% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ PPO", "methodology": "fee schedule", "standard_charge_dollar": 1853.88, "additional_payer_notes": "177.30% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1045.62, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Military Tricare", "methodology": "fee schedule", "standard_charge_dollar": 836.5, "additional_payer_notes": "80.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1045.62, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 1045.62, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC All Payer (02-01-2023 to 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 3147.0 }, { "payer_name": "UHC", "plan_name": "UHC Oxford (02-01-2023 to 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 2297.0 }, { "payer_name": "UHC - Adhoc", "plan_name": "UHC - Adhoc All Payer", "methodology": "case rate", "standard_charge_dollar": 3341.0 }, { "payer_name": "UHC - Adhoc", "plan_name": "UHC - Adhoc Oxford", "methodology": "case rate", "standard_charge_dollar": 2367.0 }, { "payer_name": "Wellcare", "plan_name": "Wellcare Insurance Exchange", "methodology": "fee schedule", "standard_charge_dollar": 1411.59, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1045.62, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellchoice", "plan_name": "WELLCHOICE HMO of NJ (Empire) Commercial (HMO / HMO POS, PPO)", "methodology": "case rate", "standard_charge_dollar": 1715.0 }, { "payer_name": "Wellchoice", "plan_name": "WELLCHOICE HMO of NJ (Empire) Commercial (Indemnity)", "methodology": "case rate", "standard_charge_dollar": 1978.0 }, { "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1045.62, "additional_payer_notes": "100.00% of Medicare Rates" } ] } ] }, { "description": "Hc Assay Of Blood Lipoprotein,Ldl Cholest", "code_information": [ { "code": "83721", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 37.28, "discounted_cash": 10.0, "minimum": 6.3, "maximum": 31.688, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 22.26, "additional_payer_notes": "212.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medical Rental Network", "methodology": "fee schedule", "standard_charge_dollar": 22.26, "additional_payer_notes": "212.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 10.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "ALLY-ALIGN (FKA SPARTAN PLAN NJ, INC.)", "plan_name": "ALLY-ALIGN (FKA SPARTAN PLAN NJ, INC.)", "methodology": "fee schedule", "standard_charge_dollar": 11.03, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Americhoice (UHC)", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 10.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Amerihealth", "plan_name": "Amerihealth Medicare", "methodology": "fee schedule", "standard_charge_dollar": 10.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 15.23, "additional_payer_notes": "Laboratory - 145.00% of Medicare Rates" }, { "payer_name": "Clover Health", "plan_name": "Clover Medicare", "methodology": "fee schedule", "standard_charge_dollar": 10.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Coventry", "plan_name": "Coventry Auto", "methodology": "fee schedule", "standard_charge_dollar": 21.0, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Coventry", "plan_name": "Coventry Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 21.0, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "fee schedule", "standard_charge_dollar": 14.7, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Fairprice Healthcare Holdings", "plan_name": "Fairprice Healthcare Holdings", "methodology": "fee schedule", "standard_charge_dollar": 12.6, "additional_payer_notes": "Laboratory - 120.00% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ HMO POS", "methodology": "fee schedule", "standard_charge_dollar": 26.32, "additional_payer_notes": "177.30% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ Indemnity", "methodology": "fee schedule", "standard_charge_dollar": 26.32, "additional_payer_notes": "177.30% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ PPO", "methodology": "fee schedule", "standard_charge_dollar": 26.32, "additional_payer_notes": "177.30% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon Medicare", "methodology": "fee schedule", "standard_charge_dollar": 10.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Military Tricare", "methodology": "fee schedule", "standard_charge_dollar": 8.4, "additional_payer_notes": "80.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 10.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 10.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC All Payer (02-01-2023 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 6.3 }, { "payer_name": "UHC", "plan_name": "UHC Medicaid (02/01/2023 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 8.4 }, { "payer_name": "UHC", "plan_name": "UHC Oxford (02-01-2023 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 6.3 }, { "payer_name": "UHC - Adhoc", "plan_name": "UHC - Adhoc All Payer", "methodology": "fee schedule", "standard_charge_dollar": 10.5 }, { "payer_name": "UHC - Adhoc", "plan_name": "UHC - Adhoc Oxford", "methodology": "fee schedule", "standard_charge_dollar": 10.5 }, { "payer_name": "Wellcare", "plan_name": "Wellcare Insurance Exchange", "methodology": "fee schedule", "standard_charge_dollar": 14.18, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 10.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup Medicare", "methodology": "fee schedule", "standard_charge_dollar": 10.5, "additional_payer_notes": "100.00% of Medicare Rates" } ] } ] }, { "description": "Hc Urinalysis, Nonauto, W/Scope", "code_information": [ { "code": "81000", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 23.0, "discounted_cash": 4.0, "minimum": 2.41, "maximum": 19.55, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 8.52, "additional_payer_notes": "212.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medical Rental Network", "methodology": "fee schedule", "standard_charge_dollar": 8.52, "additional_payer_notes": "212.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 4.02, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "ALLY-ALIGN (FKA SPARTAN PLAN NJ, INC.)", "plan_name": "ALLY-ALIGN (FKA SPARTAN PLAN NJ, INC.)", "methodology": "fee schedule", "standard_charge_dollar": 4.22, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Americhoice (UHC)", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 4.02, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Amerihealth", "plan_name": "Amerihealth Medicare", "methodology": "fee schedule", "standard_charge_dollar": 4.02, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 5.83, "additional_payer_notes": "Laboratory - 145.00% of Medicare Rates" }, { "payer_name": "Clover Health", "plan_name": "Clover Medicare", "methodology": "fee schedule", "standard_charge_dollar": 4.02, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Coventry", "plan_name": "Coventry Auto", "methodology": "fee schedule", "standard_charge_dollar": 8.04, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Coventry", "plan_name": "Coventry Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 8.04, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "fee schedule", "standard_charge_dollar": 5.63, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Fairprice Healthcare Holdings", "plan_name": "Fairprice Healthcare Holdings", "methodology": "fee schedule", "standard_charge_dollar": 4.82, "additional_payer_notes": "Laboratory - 120.00% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ HMO POS", "methodology": "fee schedule", "standard_charge_dollar": 16.24, "additional_payer_notes": "177.30% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ Indemnity", "methodology": "fee schedule", "standard_charge_dollar": 16.24, "additional_payer_notes": "177.30% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ PPO", "methodology": "fee schedule", "standard_charge_dollar": 16.24, "additional_payer_notes": "177.30% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon Medicare", "methodology": "fee schedule", "standard_charge_dollar": 4.02, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Military Tricare", "methodology": "fee schedule", "standard_charge_dollar": 3.22, "additional_payer_notes": "80.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 4.02, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 4.02, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC All Payer (02-01-2023 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 2.41 }, { "payer_name": "UHC", "plan_name": "UHC Medicaid (02/01/2023 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 3.22 }, { "payer_name": "UHC", "plan_name": "UHC Oxford (02-01-2023 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 2.41 }, { "payer_name": "UHC - Adhoc", "plan_name": "UHC - Adhoc All Payer", "methodology": "fee schedule", "standard_charge_dollar": 4.02 }, { "payer_name": "UHC - Adhoc", "plan_name": "UHC - Adhoc Oxford", "methodology": "fee schedule", "standard_charge_dollar": 4.02 }, { "payer_name": "Wellcare", "plan_name": "Wellcare Insurance Exchange", "methodology": "fee schedule", "standard_charge_dollar": 5.43, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 4.02, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup Medicare", "methodology": "fee schedule", "standard_charge_dollar": 4.02, "additional_payer_notes": "100.00% of Medicare Rates" } ] } ] }, { "description": "Hc Slctv Cath Carotid/Innom Art Angio Xtrcranl Art", "code_information": [ { "code": "36222", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 13085.5, "discounted_cash": 3732.0, "minimum": 2472.0, "maximum": 10468.4, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 7913.51, "additional_payer_notes": "212.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medical Rental Network", "methodology": "fee schedule", "standard_charge_dollar": 7913.51, "additional_payer_notes": "212.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3732.79, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "ALLY-ALIGN (FKA SPARTAN PLAN NJ, INC.)", "plan_name": "ALLY-ALIGN (FKA SPARTAN PLAN NJ, INC.)", "methodology": "fee schedule", "standard_charge_dollar": 3919.43, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Americhoice (UHC)", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3732.79, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Amerihealth", "plan_name": "Amerihealth Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3732.79, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 5485.33, "additional_payer_notes": "146.95% of Medicare Rates" }, { "payer_name": "Clover Health", "plan_name": "Clover Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3732.79, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Coventry", "plan_name": "Coventry Auto", "methodology": "fee schedule", "standard_charge_dollar": 7465.58, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Coventry", "plan_name": "Coventry Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 7465.58, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "fee schedule", "standard_charge_dollar": 5225.91, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Fairprice Healthcare Holdings", "plan_name": "Fairprice Healthcare Holdings", "methodology": "fee schedule", "standard_charge_dollar": 5972.46, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ HMO POS", "methodology": "fee schedule", "standard_charge_dollar": 6618.24, "additional_payer_notes": "177.30% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ Indemnity", "methodology": "fee schedule", "standard_charge_dollar": 6618.24, "additional_payer_notes": "177.30% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ PPO", "methodology": "fee schedule", "standard_charge_dollar": 6618.24, "additional_payer_notes": "177.30% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3732.79, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Military Tricare", "methodology": "fee schedule", "standard_charge_dollar": 2986.23, "additional_payer_notes": "80.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3732.79, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 3732.79, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC All Payer (02-01-2023 to 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 5378.0 }, { "payer_name": "UHC", "plan_name": "UHC Oxford (02-01-2023 to 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 5169.0 }, { "payer_name": "UHC - Adhoc", "plan_name": "UHC - Adhoc All Payer", "methodology": "case rate", "standard_charge_dollar": 5709.0 }, { "payer_name": "UHC - Adhoc", "plan_name": "UHC - Adhoc Oxford", "methodology": "case rate", "standard_charge_dollar": 5327.0 }, { "payer_name": "Wellcare", "plan_name": "Wellcare Insurance Exchange", "methodology": "fee schedule", "standard_charge_dollar": 5039.27, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3732.79, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellchoice", "plan_name": "WELLCHOICE HMO of NJ (Empire) Commercial (HMO / HMO POS, PPO)", "methodology": "case rate", "standard_charge_dollar": 2472.0 }, { "payer_name": "Wellchoice", "plan_name": "WELLCHOICE HMO of NJ (Empire) Commercial (Indemnity)", "methodology": "case rate", "standard_charge_dollar": 2753.0 }, { "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3732.79, "additional_payer_notes": "100.00% of Medicare Rates" } ] } ] }, { "description": "Hc Echo Tthrc R-T 2D W/Wo M-Mode Rst&Strs Cont Ecg", "code_information": [ { "code": "93351", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 2487.45, "discounted_cash": 645.0, "minimum": 474.8542, "maximum": 3242.24, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 1369.46, "additional_payer_notes": "212.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medical Rental Network", "methodology": "fee schedule", "standard_charge_dollar": 1369.46, "additional_payer_notes": "212.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 645.97, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "ALLY-ALIGN (FKA SPARTAN PLAN NJ, INC.)", "plan_name": "ALLY-ALIGN (FKA SPARTAN PLAN NJ, INC.)", "methodology": "fee schedule", "standard_charge_dollar": 678.27, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Americhoice (UHC)", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 645.97, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Amerihealth", "plan_name": "Amerihealth Medicare", "methodology": "fee schedule", "standard_charge_dollar": 645.97, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 949.25, "additional_payer_notes": "146.95% of Medicare Rates" }, { "payer_name": "Clover Health", "plan_name": "Clover Medicare", "methodology": "fee schedule", "standard_charge_dollar": 645.97, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Coventry", "plan_name": "Coventry Auto", "methodology": "fee schedule", "standard_charge_dollar": 1291.94, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Coventry", "plan_name": "Coventry Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 1291.94, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "fee schedule", "standard_charge_dollar": 904.36, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Fairprice Healthcare Holdings", "plan_name": "Fairprice Healthcare Holdings", "methodology": "fee schedule", "standard_charge_dollar": 1033.55, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ HMO POS", "methodology": "fee schedule", "standard_charge_dollar": 1145.3, "additional_payer_notes": "177.30% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ Indemnity", "methodology": "fee schedule", "standard_charge_dollar": 1145.3, "additional_payer_notes": "177.30% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ PPO", "methodology": "fee schedule", "standard_charge_dollar": 1145.3, "additional_payer_notes": "177.30% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon Medicare", "methodology": "fee schedule", "standard_charge_dollar": 645.97, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Military Tricare", "methodology": "fee schedule", "standard_charge_dollar": 516.78, "additional_payer_notes": "80.00% of Medicare Rates" }, { "payer_name": "Keenan", "plan_name": "Keenan", "methodology": "percent of total billed charges", "standard_charge_percentage": 30.0, "median_amount": 746.24, "10th_percentile": 746.24, "90th_percentile": 746.24, "count": "1 through 10" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 645.97, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 645.97, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC All Payer (02-01-2023 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 1580.0 }, { "payer_name": "UHC", "plan_name": "UHC Oxford (02-01-2023 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 1385.0 }, { "payer_name": "UHC - Adhoc", "plan_name": "UHC - Adhoc All Payer", "methodology": "fee schedule", "standard_charge_dollar": 1677.0 }, { "payer_name": "UHC - Adhoc", "plan_name": "UHC - Adhoc Oxford", "methodology": "fee schedule", "standard_charge_dollar": 1427.0 }, { "payer_name": "Wellcare", "plan_name": "Wellcare Insurance Exchange", "methodology": "fee schedule", "standard_charge_dollar": 872.06, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 645.97, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup Medicare", "methodology": "fee schedule", "standard_charge_dollar": 645.97, "additional_payer_notes": "100.00% of Medicare Rates" } ] } ] }, { "description": "RESPIRATORY FAILURE - SOI : 3", "code_information": [ { "code": "1333", "type": "APR-DRG" } ], "standard_charges": [ { "setting": "inpatient", "minimum": 13489.71, "maximum": 14838.69, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Better Health - Medi Medi", "methodology": "case rate", "standard_charge_dollar": 14838.69, "additional_payer_notes": "110% of State Medicaid Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Better Health Medicaid", "methodology": "case rate", "standard_charge_dollar": 14838.69, "additional_payer_notes": "110% of State Medicaid Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "case rate", "standard_charge_dollar": 13489.71, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "UBH", "plan_name": "UBH Medicaid", "methodology": "case rate", "standard_charge_dollar": 13489.71, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicaid (02/01/2023 to 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 13759.51, "additional_payer_notes": "102% of State Medicaid Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicaid", "methodology": "case rate", "standard_charge_dollar": 13489.71, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup Medicaid", "methodology": "case rate", "standard_charge_dollar": 13489.71, "additional_payer_notes": "100% of State Medicaid Rates" } ] } ] }, { "description": "Hc Heart Flow Reserv Measure Ea Add Vessl", "code_information": [ { "code": "93572", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 2526.0, "minimum": 482.2134, "maximum": 2526.0, "payers_information": [ { "payer_name": "Horizon", "plan_name": "Horizon NJ Health Medicaid", "methodology": "percent of total billed charges", "standard_charge_percentage": 19.58, "median_amount": 494.59, "10th_percentile": 494.59, "90th_percentile": 494.59, "count": "1 through 10" }, { "payer_name": "UHC", "plan_name": "UHC All Payer (02-01-2023 to 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 2526.0 }, { "payer_name": "UHC", "plan_name": "UHC Oxford (02-01-2023 to 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 2297.0 }, { "payer_name": "UHC - Adhoc", "plan_name": "UHC - Adhoc All Payer", "methodology": "case rate", "standard_charge_dollar": 2526.0 }, { "payer_name": "UHC - Adhoc", "plan_name": "UHC - Adhoc Oxford", "methodology": "case rate", "standard_charge_dollar": 2367.0 }, { "payer_name": "Wellchoice", "plan_name": "WELLCHOICE HMO of NJ (Empire) Commercial (HMO / HMO POS, PPO)", "methodology": "case rate", "standard_charge_dollar": 2472.0 }, { "payer_name": "Wellchoice", "plan_name": "WELLCHOICE HMO of NJ (Empire) Commercial (Indemnity)", "methodology": "case rate", "standard_charge_dollar": 2526.0 } ] } ] }, { "description": "Hc Meas,Post-Void Res,Us,Non-Imaging", "code_information": [ { "code": "51798", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 279.5, "discounted_cash": 69.0, "minimum": 53.3565, "maximum": 279.5, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 147.85, "additional_payer_notes": "212.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medical Rental Network", "methodology": "fee schedule", "standard_charge_dollar": 147.85, "additional_payer_notes": "212.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 69.74, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "ALLY-ALIGN (FKA SPARTAN PLAN NJ, INC.)", "plan_name": "ALLY-ALIGN (FKA SPARTAN PLAN NJ, INC.)", "methodology": "fee schedule", "standard_charge_dollar": 73.23, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Americhoice (UHC)", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 69.74, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Amerihealth", "plan_name": "Amerihealth Medicare", "methodology": "fee schedule", "standard_charge_dollar": 69.74, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 102.48, "additional_payer_notes": "146.95% of Medicare Rates" }, { "payer_name": "Clover Health", "plan_name": "Clover Medicare", "methodology": "fee schedule", "standard_charge_dollar": 69.74, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Coventry", "plan_name": "Coventry Auto", "methodology": "fee schedule", "standard_charge_dollar": 139.48, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Coventry", "plan_name": "Coventry Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 139.48, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "fee schedule", "standard_charge_dollar": 97.64, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Fairprice Healthcare Holdings", "plan_name": "Fairprice Healthcare Holdings", "methodology": "fee schedule", "standard_charge_dollar": 111.58, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ HMO POS", "methodology": "fee schedule", "standard_charge_dollar": 123.65, "additional_payer_notes": "177.30% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ Indemnity", "methodology": "fee schedule", "standard_charge_dollar": 123.65, "additional_payer_notes": "177.30% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ PPO", "methodology": "fee schedule", "standard_charge_dollar": 123.65, "additional_payer_notes": "177.30% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon Medicare", "methodology": "fee schedule", "standard_charge_dollar": 69.74, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Military Tricare", "methodology": "fee schedule", "standard_charge_dollar": 55.79, "additional_payer_notes": "80.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 69.74, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 69.74, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC All Payer (02-01-2023 to 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 279.5 }, { "payer_name": "UHC", "plan_name": "UHC Oxford (02-01-2023 to 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 279.5 }, { "payer_name": "UHC - Adhoc", "plan_name": "UHC - Adhoc All Payer", "methodology": "case rate", "standard_charge_dollar": 279.5 }, { "payer_name": "UHC - Adhoc", "plan_name": "UHC - Adhoc Oxford", "methodology": "case rate", "standard_charge_dollar": 279.5 }, { "payer_name": "Wellcare", "plan_name": "Wellcare Insurance Exchange", "methodology": "fee schedule", "standard_charge_dollar": 94.15, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 69.74, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup Medicare", "methodology": "fee schedule", "standard_charge_dollar": 69.74, "additional_payer_notes": "100.00% of Medicare Rates" } ] } ] }, { "description": "FULL THICKNESS BURN WITH SKIN GRAFT OR INHALATION INJURY WITH CCMCC", "code_information": [ { "code": "928", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 84447.0, "minimum": 36689.21, "maximum": 152850.5361, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "case rate", "standard_charge_dollar": 152850.54, "additional_payer_notes": "181.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medical Rental Network", "methodology": "case rate", "standard_charge_dollar": 152850.54, "additional_payer_notes": "181.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "case rate", "standard_charge_dollar": 68116.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "ALLY-ALIGN (FKA SPARTAN PLAN NJ, INC.)", "plan_name": "ALLY-ALIGN (FKA SPARTAN PLAN NJ, INC.)", "methodology": "case rate", "standard_charge_dollar": 88670.2, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Americhoice (UHC)", "plan_name": "UHC Medicare", "methodology": "case rate", "standard_charge_dollar": 68116.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Amerihealth", "plan_name": "Amerihealth Medicare", "methodology": "case rate", "standard_charge_dollar": 68116.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Commercial", "methodology": "case rate", "standard_charge_dollar": 104936.6 }, { "payer_name": "Clover Health", "plan_name": "Clover Medicare", "methodology": "case rate", "standard_charge_dollar": 68116.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Coventry", "plan_name": "Coventry Auto", "methodology": "case rate", "standard_charge_dollar": 143561.28, "additional_payer_notes": "170.00% of Medicare Rates" }, { "payer_name": "Coventry", "plan_name": "Coventry Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 143561.28, "additional_payer_notes": "170.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "case rate", "standard_charge_dollar": 109782.15, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Fairprice Healthcare Holdings", "plan_name": "Fairprice Healthcare Holdings", "methodology": "case rate", "standard_charge_dollar": 135116.5, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon Medicare", "methodology": "case rate", "standard_charge_dollar": 68116.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon NJ Health Medicaid", "methodology": "case rate", "standard_charge_dollar": 36689.21 }, { "payer_name": "Humana", "plan_name": "Humana Military Tricare", "methodology": "case rate", "standard_charge_dollar": 67558.25, "additional_payer_notes": "80.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 84447.81, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 45093.7 }, { "payer_name": "UBH", "plan_name": "UBH Medicare", "methodology": "case rate", "standard_charge_dollar": 68116.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC All Payer (02-01-2023 to 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 120903.03 }, { "payer_name": "UHC", "plan_name": "UHC Oxford (02-01-2023 to 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 105366.96 }, { "payer_name": "UHC - Adhoc", "plan_name": "UHC - Adhoc All Payer", "methodology": "case rate", "standard_charge_dollar": 128341.12 }, { "payer_name": "UHC - Adhoc", "plan_name": "UHC - Adhoc Oxford", "methodology": "case rate", "standard_charge_dollar": 108580.33 }, { "payer_name": "Wellcare", "plan_name": "Wellcare Insurance Exchange", "methodology": "case rate", "standard_charge_dollar": 114004.54, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "case rate", "standard_charge_dollar": 68116.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup Medicare", "methodology": "case rate", "standard_charge_dollar": 68116.0, "additional_payer_notes": "100.00% of Medicare Rates" } ] } ] }, { "description": "Hc Dress/Debride Burn >10% Ttl Lg", "code_information": [ { "code": "16030", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 594.0, "discounted_cash": 480.0, "minimum": 113.3946, "maximum": 594.0, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 594.0, "additional_payer_notes": "212.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medical Rental Network", "methodology": "fee schedule", "standard_charge_dollar": 594.0, "additional_payer_notes": "212.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 480.58, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "ALLY-ALIGN (FKA SPARTAN PLAN NJ, INC.)", "plan_name": "ALLY-ALIGN (FKA SPARTAN PLAN NJ, INC.)", "methodology": "fee schedule", "standard_charge_dollar": 504.61, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Americhoice (UHC)", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 480.58, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Amerihealth", "plan_name": "Amerihealth Medicare", "methodology": "fee schedule", "standard_charge_dollar": 480.58, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 594.0, "additional_payer_notes": "146.95% of Medicare Rates" }, { "payer_name": "Clover Health", "plan_name": "Clover Medicare", "methodology": "fee schedule", "standard_charge_dollar": 480.58, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Coventry", "plan_name": "Coventry Auto", "methodology": "fee schedule", "standard_charge_dollar": 594.0, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Coventry", "plan_name": "Coventry Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 594.0, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "fee schedule", "standard_charge_dollar": 594.0, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Fairprice Healthcare Holdings", "plan_name": "Fairprice Healthcare Holdings", "methodology": "fee schedule", "standard_charge_dollar": 594.0, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ HMO POS", "methodology": "fee schedule", "standard_charge_dollar": 594.0, "additional_payer_notes": "177.30% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ Indemnity", "methodology": "fee schedule", "standard_charge_dollar": 594.0, "additional_payer_notes": "177.30% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ PPO", "methodology": "fee schedule", "standard_charge_dollar": 594.0, "additional_payer_notes": "177.30% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon Medicare", "methodology": "fee schedule", "standard_charge_dollar": 480.58, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Military Tricare", "methodology": "fee schedule", "standard_charge_dollar": 384.46, "additional_payer_notes": "80.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 480.58, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 480.58, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC All Payer (02-01-2023 to 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 594.0 }, { "payer_name": "UHC", "plan_name": "UHC Oxford (02-01-2023 to 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 594.0 }, { "payer_name": "UHC - Adhoc", "plan_name": "UHC - Adhoc All Payer", "methodology": "case rate", "standard_charge_dollar": 594.0 }, { "payer_name": "UHC - Adhoc", "plan_name": "UHC - Adhoc Oxford", "methodology": "case rate", "standard_charge_dollar": 594.0 }, { "payer_name": "Wellcare", "plan_name": "Wellcare Insurance Exchange", "methodology": "fee schedule", "standard_charge_dollar": 594.0, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 480.58, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellchoice", "plan_name": "WELLCHOICE HMO of NJ (Empire) Commercial (HMO / HMO POS, PPO)", "methodology": "case rate", "standard_charge_dollar": 594.0 }, { "payer_name": "Wellchoice", "plan_name": "WELLCHOICE HMO of NJ (Empire) Commercial (Indemnity)", "methodology": "case rate", "standard_charge_dollar": 594.0 }, { "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup Medicare", "methodology": "fee schedule", "standard_charge_dollar": 480.58, "additional_payer_notes": "100.00% of Medicare Rates" } ] } ] }, { "description": "EXC FACE TUM DEEP < 2 CM", "code_information": [ { "code": "21013", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 15390.0, "discounted_cash": 1952.0, "minimum": 1562.024, "maximum": 12312.0, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 4139.36, "additional_payer_notes": "212.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medical Rental Network", "methodology": "fee schedule", "standard_charge_dollar": 4139.36, "additional_payer_notes": "212.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1952.53, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "ALLY-ALIGN (FKA SPARTAN PLAN NJ, INC.)", "plan_name": "ALLY-ALIGN (FKA SPARTAN PLAN NJ, INC.)", "methodology": "fee schedule", "standard_charge_dollar": 2050.16, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Americhoice (UHC)", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1952.53, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Amerihealth", "plan_name": "Amerihealth Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1952.53, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 2869.24, "additional_payer_notes": "146.95% of Medicare Rates" }, { "payer_name": "Clover Health", "plan_name": "Clover Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1952.53, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Coventry", "plan_name": "Coventry Auto", "methodology": "fee schedule", "standard_charge_dollar": 3905.06, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Coventry", "plan_name": "Coventry Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 3905.06, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "fee schedule", "standard_charge_dollar": 2733.54, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Fairprice Healthcare Holdings", "plan_name": "Fairprice Healthcare Holdings", "methodology": "fee schedule", "standard_charge_dollar": 3124.05, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ HMO POS", "methodology": "fee schedule", "standard_charge_dollar": 3461.84, "additional_payer_notes": "177.30% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ Indemnity", "methodology": "fee schedule", "standard_charge_dollar": 3461.84, "additional_payer_notes": "177.30% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ PPO", "methodology": "fee schedule", "standard_charge_dollar": 3461.84, "additional_payer_notes": "177.30% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1952.53, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon NJ Health Medicaid", "methodology": "percent of total billed charges", "standard_charge_percentage": 19.58, "median_amount": 3013.36, "10th_percentile": 3013.36, "90th_percentile": 3013.36, "count": "1 through 10" }, { "payer_name": "Humana", "plan_name": "Humana Military Tricare", "methodology": "fee schedule", "standard_charge_dollar": 1562.02, "additional_payer_notes": "80.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1952.53, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 1952.53, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC All Payer (02-01-2023 to 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 3147.0 }, { "payer_name": "UHC", "plan_name": "UHC Oxford (02-01-2023 to 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 2297.0 }, { "payer_name": "UHC - Adhoc", "plan_name": "UHC - Adhoc All Payer", "methodology": "case rate", "standard_charge_dollar": 3341.0 }, { "payer_name": "UHC - Adhoc", "plan_name": "UHC - Adhoc Oxford", "methodology": "case rate", "standard_charge_dollar": 2367.0 }, { "payer_name": "Wellcare", "plan_name": "Wellcare Insurance Exchange", "methodology": "fee schedule", "standard_charge_dollar": 2635.92, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1952.53, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellchoice", "plan_name": "WELLCHOICE HMO of NJ (Empire) Commercial (HMO / HMO POS, PPO)", "methodology": "case rate", "standard_charge_dollar": 1715.0 }, { "payer_name": "Wellchoice", "plan_name": "WELLCHOICE HMO of NJ (Empire) Commercial (Indemnity)", "methodology": "case rate", "standard_charge_dollar": 1978.0 }, { "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1952.53, "additional_payer_notes": "100.00% of Medicare Rates" } ] } ] }, { "description": "Release finger contracture", "code_information": [ { "code": "26525", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 4949.06, "discounted_cash": 1900.0, "minimum": 944.7756, "maximum": 4153.0, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 4030.06, "additional_payer_notes": "212.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medical Rental Network", "methodology": "fee schedule", "standard_charge_dollar": 4030.06, "additional_payer_notes": "212.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1900.97, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "ALLY-ALIGN (FKA SPARTAN PLAN NJ, INC.)", "plan_name": "ALLY-ALIGN (FKA SPARTAN PLAN NJ, INC.)", "methodology": "fee schedule", "standard_charge_dollar": 1996.02, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Americhoice (UHC)", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1900.97, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Amerihealth", "plan_name": "Amerihealth Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1900.97, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 2793.48, "additional_payer_notes": "146.95% of Medicare Rates" }, { "payer_name": "Clover Health", "plan_name": "Clover Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1900.97, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Coventry", "plan_name": "Coventry Auto", "methodology": "fee schedule", "standard_charge_dollar": 3801.94, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Coventry", "plan_name": "Coventry Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 3801.94, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "fee schedule", "standard_charge_dollar": 2661.36, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Fairprice Healthcare Holdings", "plan_name": "Fairprice Healthcare Holdings", "methodology": "fee schedule", "standard_charge_dollar": 3041.55, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ HMO POS", "methodology": "fee schedule", "standard_charge_dollar": 3370.42, "additional_payer_notes": "177.30% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ Indemnity", "methodology": "fee schedule", "standard_charge_dollar": 3370.42, "additional_payer_notes": "177.30% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ PPO", "methodology": "fee schedule", "standard_charge_dollar": 3370.42, "additional_payer_notes": "177.30% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1900.97, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon NJ Health Medicaid", "methodology": "percent of total billed charges", "standard_charge_percentage": 19.58, "median_amount": 1059.15, "10th_percentile": 1059.15, "90th_percentile": 1059.15, "count": "1 through 10" }, { "payer_name": "Humana", "plan_name": "Humana Military Tricare", "methodology": "fee schedule", "standard_charge_dollar": 1520.78, "additional_payer_notes": "80.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1900.97, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 1900.97, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC All Payer (02-01-2023 to 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 3912.0 }, { "payer_name": "UHC", "plan_name": "UHC Oxford (02-01-2023 to 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 3676.0 }, { "payer_name": "UHC - Adhoc", "plan_name": "UHC - Adhoc All Payer", "methodology": "case rate", "standard_charge_dollar": 4153.0 }, { "payer_name": "UHC - Adhoc", "plan_name": "UHC - Adhoc Oxford", "methodology": "case rate", "standard_charge_dollar": 3788.0 }, { "payer_name": "Wellcare", "plan_name": "Wellcare Insurance Exchange", "methodology": "fee schedule", "standard_charge_dollar": 2566.31, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1900.97, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellchoice", "plan_name": "WELLCHOICE HMO of NJ (Empire) Commercial (HMO / HMO POS, PPO)", "methodology": "case rate", "standard_charge_dollar": 1715.0 }, { "payer_name": "Wellchoice", "plan_name": "WELLCHOICE HMO of NJ (Empire) Commercial (Indemnity)", "methodology": "case rate", "standard_charge_dollar": 1978.0 }, { "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1900.97, "additional_payer_notes": "100.00% of Medicare Rates" } ] } ] }, { "description": "COLPOPEXY INTRAPERITONEAL", "code_information": [ { "code": "57283", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 19060.41, "discounted_cash": 8766.0, "minimum": 1715.0, "maximum": 18585.1072, "payers_information": [ { "payer_name": "Wellcare", "plan_name": "Wellcare Insurance Exchange", "methodology": "fee schedule", "standard_charge_dollar": 11834.86, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 8766.56, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellchoice", "plan_name": "WELLCHOICE HMO of NJ (Empire) Commercial (HMO / HMO POS, PPO)", "methodology": "case rate", "standard_charge_dollar": 1715.0 }, { "payer_name": "Wellchoice", "plan_name": "WELLCHOICE HMO of NJ (Empire) Commercial (Indemnity)", "methodology": "case rate", "standard_charge_dollar": 1978.0 }, { "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup Medicare", "methodology": "fee schedule", "standard_charge_dollar": 8766.56, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 18585.11, "additional_payer_notes": "212.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medical Rental Network", "methodology": "fee schedule", "standard_charge_dollar": 18585.11, "additional_payer_notes": "212.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 8766.56, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "ALLY-ALIGN (FKA SPARTAN PLAN NJ, INC.)", "plan_name": "ALLY-ALIGN (FKA SPARTAN PLAN NJ, INC.)", "methodology": "fee schedule", "standard_charge_dollar": 9204.89, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Americhoice (UHC)", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 8766.56, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Amerihealth", "plan_name": "Amerihealth Medicare", "methodology": "fee schedule", "standard_charge_dollar": 8766.56, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 12882.46, "additional_payer_notes": "146.95% of Medicare Rates" }, { "payer_name": "Clover Health", "plan_name": "Clover Medicare", "methodology": "fee schedule", "standard_charge_dollar": 8766.56, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Coventry", "plan_name": "Coventry Auto", "methodology": "fee schedule", "standard_charge_dollar": 17533.12, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Coventry", "plan_name": "Coventry Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 17533.12, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "fee schedule", "standard_charge_dollar": 12273.18, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Fairprice Healthcare Holdings", "plan_name": "Fairprice Healthcare Holdings", "methodology": "fee schedule", "standard_charge_dollar": 14026.5, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ HMO POS", "methodology": "fee schedule", "standard_charge_dollar": 15543.11, "additional_payer_notes": "177.30% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ Indemnity", "methodology": "fee schedule", "standard_charge_dollar": 15543.11, "additional_payer_notes": "177.30% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ PPO", "methodology": "fee schedule", "standard_charge_dollar": 15543.11, "additional_payer_notes": "177.30% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon Medicare", "methodology": "fee schedule", "standard_charge_dollar": 8766.56, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Military Tricare", "methodology": "fee schedule", "standard_charge_dollar": 7013.25, "additional_payer_notes": "80.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 8766.56, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 8766.56, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC All Payer (02-01-2023 to 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 5667.0 }, { "payer_name": "UHC", "plan_name": "UHC Oxford (02-01-2023 to 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 5169.0 }, { "payer_name": "UHC - Adhoc", "plan_name": "UHC - Adhoc All Payer", "methodology": "case rate", "standard_charge_dollar": 6016.0 }, { "payer_name": "UHC - Adhoc", "plan_name": "UHC - Adhoc Oxford", "methodology": "case rate", "standard_charge_dollar": 5327.0 } ] } ] }, { "description": "OTHER KIDNEY & URINARY TRACT DIAGNOSES, SIGNS & SYMPTOMS - SOI : 4", "code_information": [ { "code": "4684", "type": "APR-DRG" } ], "standard_charges": [ { "setting": "inpatient", "minimum": 21654.39, "maximum": 23819.83, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Better Health - Medi Medi", "methodology": "case rate", "standard_charge_dollar": 23819.83, "additional_payer_notes": "110% of State Medicaid Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Better Health Medicaid", "methodology": "case rate", "standard_charge_dollar": 23819.83, "additional_payer_notes": "110% of State Medicaid Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "case rate", "standard_charge_dollar": 21654.39, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "UBH", "plan_name": "UBH Medicaid", "methodology": "case rate", "standard_charge_dollar": 21654.39, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicaid (02/01/2023 to 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 22087.48, "additional_payer_notes": "102% of State Medicaid Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicaid", "methodology": "case rate", "standard_charge_dollar": 21654.39, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup Medicaid", "methodology": "case rate", "standard_charge_dollar": 21654.39, "additional_payer_notes": "100% of State Medicaid Rates" } ] } ] }, { "description": "Exc Hand Les Sc 1.5 Cm/>", "code_information": [ { "code": "26111", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 15390.0, "discounted_cash": 1952.0, "minimum": 1562.024, "maximum": 12312.0, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 4139.36, "additional_payer_notes": "212.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medical Rental Network", "methodology": "fee schedule", "standard_charge_dollar": 4139.36, "additional_payer_notes": "212.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1952.53, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "ALLY-ALIGN (FKA SPARTAN PLAN NJ, INC.)", "plan_name": "ALLY-ALIGN (FKA SPARTAN PLAN NJ, INC.)", "methodology": "fee schedule", "standard_charge_dollar": 2050.16, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Americhoice (UHC)", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1952.53, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Amerihealth", "plan_name": "Amerihealth Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1952.53, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 2869.24, "additional_payer_notes": "146.95% of Medicare Rates" }, { "payer_name": "Clover Health", "plan_name": "Clover Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1952.53, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Coventry", "plan_name": "Coventry Auto", "methodology": "fee schedule", "standard_charge_dollar": 3905.06, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Coventry", "plan_name": "Coventry Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 3905.06, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "fee schedule", "standard_charge_dollar": 2733.54, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Fairprice Healthcare Holdings", "plan_name": "Fairprice Healthcare Holdings", "methodology": "fee schedule", "standard_charge_dollar": 3124.05, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ HMO POS", "methodology": "fee schedule", "standard_charge_dollar": 3461.84, "additional_payer_notes": "177.30% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ Indemnity", "methodology": "fee schedule", "standard_charge_dollar": 3461.84, "additional_payer_notes": "177.30% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ PPO", "methodology": "fee schedule", "standard_charge_dollar": 3461.84, "additional_payer_notes": "177.30% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1952.53, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Military Tricare", "methodology": "fee schedule", "standard_charge_dollar": 1562.02, "additional_payer_notes": "80.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1952.53, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 1952.53, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC All Payer (02-01-2023 to 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 4415.0 }, { "payer_name": "UHC", "plan_name": "UHC Oxford (02-01-2023 to 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 4020.0 }, { "payer_name": "UHC - Adhoc", "plan_name": "UHC - Adhoc All Payer", "methodology": "case rate", "standard_charge_dollar": 4687.0 }, { "payer_name": "UHC - Adhoc", "plan_name": "UHC - Adhoc Oxford", "methodology": "case rate", "standard_charge_dollar": 4143.0 }, { "payer_name": "Wellcare", "plan_name": "Wellcare Insurance Exchange", "methodology": "fee schedule", "standard_charge_dollar": 2635.92, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1952.53, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellchoice", "plan_name": "WELLCHOICE HMO of NJ (Empire) Commercial (HMO / HMO POS, PPO)", "methodology": "case rate", "standard_charge_dollar": 1715.0 }, { "payer_name": "Wellchoice", "plan_name": "WELLCHOICE HMO of NJ (Empire) Commercial (Indemnity)", "methodology": "case rate", "standard_charge_dollar": 1978.0 }, { "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1952.53, "additional_payer_notes": "100.00% of Medicare Rates" } ] } ] }, { "description": "Revise Arm/Leg Nerve", "code_information": [ { "code": "64708", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 56257.5, "discounted_cash": 2308.0, "minimum": 1715.0, "maximum": 45006.0, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 4894.04, "additional_payer_notes": "212.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medical Rental Network", "methodology": "fee schedule", "standard_charge_dollar": 4894.04, "additional_payer_notes": "212.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2308.51, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "ALLY-ALIGN (FKA SPARTAN PLAN NJ, INC.)", "plan_name": "ALLY-ALIGN (FKA SPARTAN PLAN NJ, INC.)", "methodology": "fee schedule", "standard_charge_dollar": 2423.94, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Americhoice (UHC)", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2308.51, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Amerihealth", "plan_name": "Amerihealth Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2308.51, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 3392.36, "additional_payer_notes": "146.95% of Medicare Rates" }, { "payer_name": "Clover Health", "plan_name": "Clover Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2308.51, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Coventry", "plan_name": "Coventry Auto", "methodology": "fee schedule", "standard_charge_dollar": 4617.02, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Coventry", "plan_name": "Coventry Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 4617.02, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "fee schedule", "standard_charge_dollar": 3231.91, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Fairprice Healthcare Holdings", "plan_name": "Fairprice Healthcare Holdings", "methodology": "fee schedule", "standard_charge_dollar": 3693.62, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ HMO POS", "methodology": "fee schedule", "standard_charge_dollar": 4092.99, "additional_payer_notes": "177.30% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ Indemnity", "methodology": "fee schedule", "standard_charge_dollar": 4092.99, "additional_payer_notes": "177.30% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ PPO", "methodology": "fee schedule", "standard_charge_dollar": 4092.99, "additional_payer_notes": "177.30% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2308.51, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon NJ Health Medicaid", "methodology": "percent of total billed charges", "standard_charge_percentage": 19.58, "median_amount": 1977.09, "10th_percentile": 1004.45, "90th_percentile": 4236.62, "count": "1 through 10" }, { "payer_name": "Humana", "plan_name": "Humana Military Tricare", "methodology": "fee schedule", "standard_charge_dollar": 1846.81, "additional_payer_notes": "80.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2308.51, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 2308.51, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC All Payer (02-01-2023 to 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 4415.0 }, { "payer_name": "UHC", "plan_name": "UHC Oxford (02-01-2023 to 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 4020.0 }, { "payer_name": "UHC - Adhoc", "plan_name": "UHC - Adhoc All Payer", "methodology": "case rate", "standard_charge_dollar": 4687.0 }, { "payer_name": "UHC - Adhoc", "plan_name": "UHC - Adhoc Oxford", "methodology": "case rate", "standard_charge_dollar": 4143.0 }, { "payer_name": "Wellcare", "plan_name": "Wellcare Insurance Exchange", "methodology": "fee schedule", "standard_charge_dollar": 3116.49, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2308.51, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellchoice", "plan_name": "WELLCHOICE HMO of NJ (Empire) Commercial (HMO / HMO POS, PPO)", "methodology": "case rate", "standard_charge_dollar": 1715.0 }, { "payer_name": "Wellchoice", "plan_name": "WELLCHOICE HMO of NJ (Empire) Commercial (Indemnity)", "methodology": "case rate", "standard_charge_dollar": 1978.0 }, { "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2308.51, "additional_payer_notes": "100.00% of Medicare Rates" } ] } ] }, { "description": "Hc Car Seat/Bed Test Ea 30 Min", "code_information": [ { "code": "94781", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 129.0, "minimum": 24.6261, "maximum": 129.0, "payers_information": [ { "payer_name": "UHC", "plan_name": "UHC All Payer (02-01-2023 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 129.0 }, { "payer_name": "UHC", "plan_name": "UHC Oxford (02-01-2023 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 129.0 }, { "payer_name": "UHC - Adhoc", "plan_name": "UHC - Adhoc All Payer", "methodology": "fee schedule", "standard_charge_dollar": 129.0 }, { "payer_name": "UHC - Adhoc", "plan_name": "UHC - Adhoc Oxford", "methodology": "fee schedule", "standard_charge_dollar": 129.0 } ] } ] }, { "description": "OTHER INFECTIOUS & PARASITIC DISEASES - SOI : 1", "code_information": [ { "code": "7241", "type": "APR-DRG" } ], "standard_charges": [ { "setting": "inpatient", "minimum": 7199.24, "maximum": 7919.17, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Better Health - Medi Medi", "methodology": "case rate", "standard_charge_dollar": 7919.17, "additional_payer_notes": "110% of State Medicaid Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Better Health Medicaid", "methodology": "case rate", "standard_charge_dollar": 7919.17, "additional_payer_notes": "110% of State Medicaid Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "case rate", "standard_charge_dollar": 7199.24, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "UBH", "plan_name": "UBH Medicaid", "methodology": "case rate", "standard_charge_dollar": 7199.24, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicaid (02/01/2023 to 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 7343.23, "additional_payer_notes": "102% of State Medicaid Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicaid", "methodology": "case rate", "standard_charge_dollar": 7199.24, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup Medicaid", "methodology": "case rate", "standard_charge_dollar": 7199.24, "additional_payer_notes": "100% of State Medicaid Rates" } ] } ] }, { "description": "Hc Thyroid Met Imaging Body", "code_information": [ { "code": "78018", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 2339.5, "discounted_cash": 641.0, "minimum": 399.78, "maximum": 1988.575, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 1360.83, "additional_payer_notes": "212.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medical Rental Network", "methodology": "fee schedule", "standard_charge_dollar": 1360.83, "additional_payer_notes": "212.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 641.9, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "ALLY-ALIGN (FKA SPARTAN PLAN NJ, INC.)", "plan_name": "ALLY-ALIGN (FKA SPARTAN PLAN NJ, INC.)", "methodology": "fee schedule", "standard_charge_dollar": 674.0, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Americhoice (UHC)", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 641.9, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Amerihealth", "plan_name": "Amerihealth HMO", "methodology": "fee schedule", "standard_charge_dollar": 399.78 }, { "payer_name": "Amerihealth", "plan_name": "Amerihealth Medicare", "methodology": "fee schedule", "standard_charge_dollar": 641.9, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 943.27, "additional_payer_notes": "146.95% of Medicare Rates" }, { "payer_name": "Clover Health", "plan_name": "Clover Medicare", "methodology": "fee schedule", "standard_charge_dollar": 641.9, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Coventry", "plan_name": "Coventry Auto", "methodology": "fee schedule", "standard_charge_dollar": 1283.8, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Coventry", "plan_name": "Coventry Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 1283.8, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "fee schedule", "standard_charge_dollar": 898.66, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Fairprice Healthcare Holdings", "plan_name": "Fairprice Healthcare Holdings", "methodology": "fee schedule", "standard_charge_dollar": 1027.04, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ HMO POS", "methodology": "fee schedule", "standard_charge_dollar": 1138.09, "additional_payer_notes": "177.30% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ Indemnity", "methodology": "fee schedule", "standard_charge_dollar": 1138.09, "additional_payer_notes": "177.30% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ PPO", "methodology": "fee schedule", "standard_charge_dollar": 1138.09, "additional_payer_notes": "177.30% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon Medicare", "methodology": "fee schedule", "standard_charge_dollar": 641.9, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Military Tricare", "methodology": "fee schedule", "standard_charge_dollar": 513.52, "additional_payer_notes": "80.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 641.9, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 641.9, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC All Payer (02-01-2023 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 734.1 }, { "payer_name": "UHC", "plan_name": "UHC Oxford (02-01-2023 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 734.1 }, { "payer_name": "UHC - Adhoc", "plan_name": "UHC - Adhoc All Payer", "methodology": "fee schedule", "standard_charge_dollar": 489.4 }, { "payer_name": "UHC - Adhoc", "plan_name": "UHC - Adhoc Oxford", "methodology": "fee schedule", "standard_charge_dollar": 489.4 }, { "payer_name": "Wellcare", "plan_name": "Wellcare Insurance Exchange", "methodology": "fee schedule", "standard_charge_dollar": 866.57, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 641.9, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup Medicare", "methodology": "fee schedule", "standard_charge_dollar": 641.9, "additional_payer_notes": "100.00% of Medicare Rates" } ] } ] }, { "description": "Incise & Drain Bladder", "code_information": [ { "code": "51040", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 15390.0, "discounted_cash": 2471.0, "minimum": 1715.0, "maximum": 12312.0, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 5239.07, "additional_payer_notes": "212.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medical Rental Network", "methodology": "fee schedule", "standard_charge_dollar": 5239.07, "additional_payer_notes": "212.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2471.26, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "ALLY-ALIGN (FKA SPARTAN PLAN NJ, INC.)", "plan_name": "ALLY-ALIGN (FKA SPARTAN PLAN NJ, INC.)", "methodology": "fee schedule", "standard_charge_dollar": 2594.82, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Americhoice (UHC)", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2471.26, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Amerihealth", "plan_name": "Amerihealth Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2471.26, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 3631.52, "additional_payer_notes": "146.95% of Medicare Rates" }, { "payer_name": "Clover Health", "plan_name": "Clover Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2471.26, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Coventry", "plan_name": "Coventry Auto", "methodology": "fee schedule", "standard_charge_dollar": 4942.52, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Coventry", "plan_name": "Coventry Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 4942.52, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "fee schedule", "standard_charge_dollar": 3459.76, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Fairprice Healthcare Holdings", "plan_name": "Fairprice Healthcare Holdings", "methodology": "fee schedule", "standard_charge_dollar": 3954.02, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ HMO POS", "methodology": "fee schedule", "standard_charge_dollar": 4381.54, "additional_payer_notes": "177.30% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ Indemnity", "methodology": "fee schedule", "standard_charge_dollar": 4381.54, "additional_payer_notes": "177.30% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ PPO", "methodology": "fee schedule", "standard_charge_dollar": 4381.54, "additional_payer_notes": "177.30% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2471.26, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Military Tricare", "methodology": "fee schedule", "standard_charge_dollar": 1977.01, "additional_payer_notes": "80.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2471.26, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 2471.26, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC All Payer (02-01-2023 to 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 4415.0 }, { "payer_name": "UHC", "plan_name": "UHC Oxford (02-01-2023 to 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 4020.0 }, { "payer_name": "UHC - Adhoc", "plan_name": "UHC - Adhoc All Payer", "methodology": "case rate", "standard_charge_dollar": 4687.0 }, { "payer_name": "UHC - Adhoc", "plan_name": "UHC - Adhoc Oxford", "methodology": "case rate", "standard_charge_dollar": 4143.0 }, { "payer_name": "Wellcare", "plan_name": "Wellcare Insurance Exchange", "methodology": "fee schedule", "standard_charge_dollar": 3336.2, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2471.26, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellchoice", "plan_name": "WELLCHOICE HMO of NJ (Empire) Commercial (HMO / HMO POS, PPO)", "methodology": "case rate", "standard_charge_dollar": 1715.0 }, { "payer_name": "Wellchoice", "plan_name": "WELLCHOICE HMO of NJ (Empire) Commercial (Indemnity)", "methodology": "case rate", "standard_charge_dollar": 1978.0 }, { "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2471.26, "additional_payer_notes": "100.00% of Medicare Rates" } ] } ] }, { "description": "Hc Nm Bone Imaging, Limited Area", "code_information": [ { "code": "78300", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 719.0, "discounted_cash": 472.0, "minimum": 137.2571, "maximum": 719.0, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 719.0, "additional_payer_notes": "212.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medical Rental Network", "methodology": "fee schedule", "standard_charge_dollar": 719.0, "additional_payer_notes": "212.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 472.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "ALLY-ALIGN (FKA SPARTAN PLAN NJ, INC.)", "plan_name": "ALLY-ALIGN (FKA SPARTAN PLAN NJ, INC.)", "methodology": "fee schedule", "standard_charge_dollar": 496.23, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Americhoice (UHC)", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 472.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Amerihealth", "plan_name": "Amerihealth HMO", "methodology": "fee schedule", "standard_charge_dollar": 199.89 }, { "payer_name": "Amerihealth", "plan_name": "Amerihealth Medicare", "methodology": "fee schedule", "standard_charge_dollar": 472.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 694.49, "additional_payer_notes": "146.95% of Medicare Rates" }, { "payer_name": "Clover Health", "plan_name": "Clover Medicare", "methodology": "fee schedule", "standard_charge_dollar": 472.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Coventry", "plan_name": "Coventry Auto", "methodology": "fee schedule", "standard_charge_dollar": 719.0, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Coventry", "plan_name": "Coventry Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 719.0, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "fee schedule", "standard_charge_dollar": 661.64, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Fairprice Healthcare Holdings", "plan_name": "Fairprice Healthcare Holdings", "methodology": "fee schedule", "standard_charge_dollar": 719.0, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ HMO POS", "methodology": "fee schedule", "standard_charge_dollar": 719.0, "additional_payer_notes": "177.30% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ Indemnity", "methodology": "fee schedule", "standard_charge_dollar": 719.0, "additional_payer_notes": "177.30% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ PPO", "methodology": "fee schedule", "standard_charge_dollar": 719.0, "additional_payer_notes": "177.30% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon Medicare", "methodology": "fee schedule", "standard_charge_dollar": 472.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Military Tricare", "methodology": "fee schedule", "standard_charge_dollar": 378.08, "additional_payer_notes": "80.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 472.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 472.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC All Payer (02-01-2023 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 565.68 }, { "payer_name": "UHC", "plan_name": "UHC Oxford (02-01-2023 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 565.68 }, { "payer_name": "UHC - Adhoc", "plan_name": "UHC - Adhoc All Payer", "methodology": "fee schedule", "standard_charge_dollar": 377.12 }, { "payer_name": "UHC - Adhoc", "plan_name": "UHC - Adhoc Oxford", "methodology": "fee schedule", "standard_charge_dollar": 377.12 }, { "payer_name": "Wellcare", "plan_name": "Wellcare Insurance Exchange", "methodology": "fee schedule", "standard_charge_dollar": 638.01, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 472.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup Medicare", "methodology": "fee schedule", "standard_charge_dollar": 472.6, "additional_payer_notes": "100.00% of Medicare Rates" } ] } ] }, { "description": "Unlisted laps px stomach", "code_information": [ { "code": "43659", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 15613.88, "discounted_cash": 7147.0, "minimum": 1715.0, "maximum": 15151.746, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 15151.75, "additional_payer_notes": "212.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medical Rental Network", "methodology": "fee schedule", "standard_charge_dollar": 15151.75, "additional_payer_notes": "212.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 7147.05, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "ALLY-ALIGN (FKA SPARTAN PLAN NJ, INC.)", "plan_name": "ALLY-ALIGN (FKA SPARTAN PLAN NJ, INC.)", "methodology": "fee schedule", "standard_charge_dollar": 7504.4, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Americhoice (UHC)", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 7147.05, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Amerihealth", "plan_name": "Amerihealth Medicare", "methodology": "fee schedule", "standard_charge_dollar": 7147.05, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 10502.59, "additional_payer_notes": "146.95% of Medicare Rates" }, { "payer_name": "Clover Health", "plan_name": "Clover Medicare", "methodology": "fee schedule", "standard_charge_dollar": 7147.05, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Coventry", "plan_name": "Coventry Auto", "methodology": "fee schedule", "standard_charge_dollar": 14294.1, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Coventry", "plan_name": "Coventry Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 14294.1, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "fee schedule", "standard_charge_dollar": 10005.87, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Fairprice Healthcare Holdings", "plan_name": "Fairprice Healthcare Holdings", "methodology": "fee schedule", "standard_charge_dollar": 11435.28, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ HMO POS", "methodology": "fee schedule", "standard_charge_dollar": 12671.72, "additional_payer_notes": "177.30% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ Indemnity", "methodology": "fee schedule", "standard_charge_dollar": 12671.72, "additional_payer_notes": "177.30% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ PPO", "methodology": "fee schedule", "standard_charge_dollar": 12671.72, "additional_payer_notes": "177.30% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon Medicare", "methodology": "fee schedule", "standard_charge_dollar": 7147.05, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Military Tricare", "methodology": "fee schedule", "standard_charge_dollar": 5717.64, "additional_payer_notes": "80.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 7147.05, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 7147.05, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC All Payer (02-01-2023 to 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 5667.0 }, { "payer_name": "UHC", "plan_name": "UHC Oxford (02-01-2023 to 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 5169.0 }, { "payer_name": "UHC - Adhoc", "plan_name": "UHC - Adhoc All Payer", "methodology": "case rate", "standard_charge_dollar": 6016.0 }, { "payer_name": "UHC - Adhoc", "plan_name": "UHC - Adhoc Oxford", "methodology": "case rate", "standard_charge_dollar": 5327.0 }, { "payer_name": "Wellcare", "plan_name": "Wellcare Insurance Exchange", "methodology": "fee schedule", "standard_charge_dollar": 9648.52, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 7147.05, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellchoice", "plan_name": "WELLCHOICE HMO of NJ (Empire) Commercial (HMO / HMO POS, PPO)", "methodology": "case rate", "standard_charge_dollar": 1715.0 }, { "payer_name": "Wellchoice", "plan_name": "WELLCHOICE HMO of NJ (Empire) Commercial (Indemnity)", "methodology": "case rate", "standard_charge_dollar": 1978.0 }, { "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup Medicare", "methodology": "fee schedule", "standard_charge_dollar": 7147.05, "additional_payer_notes": "100.00% of Medicare Rates" } ] } ] }, { "description": "KIDNEY TRANSPLANT - SOI : 1", "code_information": [ { "code": "4401", "type": "APR-DRG" } ], "standard_charges": [ { "setting": "inpatient", "minimum": 55736.38, "maximum": 61310.02, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Better Health - Medi Medi", "methodology": "case rate", "standard_charge_dollar": 61310.02, "additional_payer_notes": "110% of State Medicaid Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Better Health Medicaid", "methodology": "case rate", "standard_charge_dollar": 61310.02, "additional_payer_notes": "110% of State Medicaid Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "case rate", "standard_charge_dollar": 55736.38, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "UBH", "plan_name": "UBH Medicaid", "methodology": "case rate", "standard_charge_dollar": 55736.38, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicaid (02/01/2023 to 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 56851.11, "additional_payer_notes": "102% of State Medicaid Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicaid", "methodology": "case rate", "standard_charge_dollar": 55736.38, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup Medicaid", "methodology": "case rate", "standard_charge_dollar": 55736.38, "additional_payer_notes": "100% of State Medicaid Rates" } ] } ] }, { "description": "Hc Eval,Oral & Pharyngeal Swallow Function, 90 Min", "code_information": [ { "code": "92610", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 435.0, "discounted_cash": 62.0, "minimum": 50.232, "maximum": 432.0, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 133.11, "additional_payer_notes": "212.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medical Rental Network", "methodology": "fee schedule", "standard_charge_dollar": 133.11, "additional_payer_notes": "212.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 62.79, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "ALLY-ALIGN (FKA SPARTAN PLAN NJ, INC.)", "plan_name": "ALLY-ALIGN (FKA SPARTAN PLAN NJ, INC.)", "methodology": "fee schedule", "standard_charge_dollar": 65.93, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Americhoice (UHC)", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 62.79, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Amerihealth", "plan_name": "Amerihealth Medicare", "methodology": "fee schedule", "standard_charge_dollar": 62.79, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 158.0, "additional_payer_notes": "A Indicator - 155.00% of Medicare Rates" }, { "payer_name": "Clover Health", "plan_name": "Clover Medicare", "methodology": "fee schedule", "standard_charge_dollar": 62.79, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Coventry", "plan_name": "Coventry Auto", "methodology": "fee schedule", "standard_charge_dollar": 125.58, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Coventry", "plan_name": "Coventry Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 125.58, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "fee schedule", "standard_charge_dollar": 87.91, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Fairprice Healthcare Holdings", "plan_name": "Fairprice Healthcare Holdings", "methodology": "fee schedule", "standard_charge_dollar": 100.46 }, { "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ HMO POS", "methodology": "fee schedule", "standard_charge_dollar": 307.11, "additional_payer_notes": "177.30% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ Indemnity", "methodology": "fee schedule", "standard_charge_dollar": 307.11, "additional_payer_notes": "177.30% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ PPO", "methodology": "fee schedule", "standard_charge_dollar": 307.11, "additional_payer_notes": "177.30% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon Medicare", "methodology": "fee schedule", "standard_charge_dollar": 62.79, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon NJ Health Medicaid", "methodology": "percent of total billed charges", "standard_charge_percentage": 19.58, "median_amount": 93.09, "10th_percentile": 93.09, "90th_percentile": 94.17, "count": "1 through 10" }, { "payer_name": "Humana", "plan_name": "Humana Military Tricare", "methodology": "fee schedule", "standard_charge_dollar": 50.23, "additional_payer_notes": "80.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 62.79, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 62.79, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC All Payer (02-01-2023 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 407.0 }, { "payer_name": "UHC", "plan_name": "UHC Medicaid (02/01/2023 to 12-31-2026)", "methodology": "percent of total billed charges", "standard_charge_percentage": 19.47, "median_amount": 94.17, "10th_percentile": 93.09, "90th_percentile": 94.17, "count": "1 through 10" }, { "payer_name": "UHC", "plan_name": "UHC Oxford (02-01-2023 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 357.0 }, { "payer_name": "UHC - Adhoc", "plan_name": "UHC - Adhoc All Payer", "methodology": "fee schedule", "standard_charge_dollar": 432.0 }, { "payer_name": "UHC - Adhoc", "plan_name": "UHC - Adhoc Oxford", "methodology": "fee schedule", "standard_charge_dollar": 368.0 }, { "payer_name": "Wellcare", "plan_name": "Wellcare Insurance Exchange", "methodology": "fee schedule", "standard_charge_dollar": 84.77, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 62.79, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup Medicaid", "methodology": "percent of total billed charges", "standard_charge_percentage": 19.09, "median_amount": 81.13, "10th_percentile": 81.13, "90th_percentile": 93.09, "count": "1 through 10" }, { "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup Medicare", "methodology": "fee schedule", "standard_charge_dollar": 62.79, "additional_payer_notes": "100.00% of Medicare Rates" } ] } ] }, { "description": "CORONARY BYPASS WITH CARDIAC CATHETERIZATION OR OPEN ABLATION WITH MCC", "code_information": [ { "code": "233", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 89908.0, "minimum": 47692.35, "maximum": 162733.9144, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "case rate", "standard_charge_dollar": 162733.91, "additional_payer_notes": "181.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medical Rental Network", "methodology": "case rate", "standard_charge_dollar": 162733.91, "additional_payer_notes": "181.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "case rate", "standard_charge_dollar": 72500.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "ALLY-ALIGN (FKA SPARTAN PLAN NJ, INC.)", "plan_name": "ALLY-ALIGN (FKA SPARTAN PLAN NJ, INC.)", "methodology": "case rate", "standard_charge_dollar": 94403.65, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Americhoice (UHC)", "plan_name": "UHC Medicare", "methodology": "case rate", "standard_charge_dollar": 72500.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Amerihealth", "plan_name": "Amerihealth Medicare", "methodology": "case rate", "standard_charge_dollar": 72500.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Commercial", "methodology": "case rate", "standard_charge_dollar": 111849.28 }, { "payer_name": "Clover Health", "plan_name": "Clover Medicare", "methodology": "case rate", "standard_charge_dollar": 72500.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Coventry", "plan_name": "Coventry Auto", "methodology": "case rate", "standard_charge_dollar": 152844.01, "additional_payer_notes": "170.00% of Medicare Rates" }, { "payer_name": "Coventry", "plan_name": "Coventry Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 152844.01, "additional_payer_notes": "170.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "case rate", "standard_charge_dollar": 116880.71, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Fairprice Healthcare Holdings", "plan_name": "Fairprice Healthcare Holdings", "methodology": "case rate", "standard_charge_dollar": 143853.18, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon Medicare", "methodology": "case rate", "standard_charge_dollar": 72500.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon NJ Health Medicaid", "methodology": "case rate", "standard_charge_dollar": 47692.35 }, { "payer_name": "Humana", "plan_name": "Humana Military Tricare", "methodology": "case rate", "standard_charge_dollar": 71926.59, "additional_payer_notes": "80.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 89908.24, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 102858.0 }, { "payer_name": "UBH", "plan_name": "UBH Medicare", "methodology": "case rate", "standard_charge_dollar": 72500.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC All Payer (02-01-2023 to 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 128867.49 }, { "payer_name": "UHC", "plan_name": "UHC Oxford (02-01-2023 to 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 112307.99 }, { "payer_name": "UHC - Adhoc", "plan_name": "UHC - Adhoc All Payer", "methodology": "case rate", "standard_charge_dollar": 136795.56 }, { "payer_name": "UHC - Adhoc", "plan_name": "UHC - Adhoc Oxford", "methodology": "case rate", "standard_charge_dollar": 115733.04 }, { "payer_name": "Wellcare", "plan_name": "Wellcare Insurance Exchange", "methodology": "case rate", "standard_charge_dollar": 121376.12, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "case rate", "standard_charge_dollar": 72500.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup Medicare", "methodology": "case rate", "standard_charge_dollar": 72500.6, "additional_payer_notes": "100.00% of Medicare Rates" } ] } ] }, { "description": "Hc Incision & Drain Of Hematoma/Fluid", "code_information": [ { "code": "10140", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 6655.86, "discounted_cash": 1952.0, "minimum": 1270.6037, "maximum": 13464.0, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 4139.36, "additional_payer_notes": "212.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medical Rental Network", "methodology": "fee schedule", "standard_charge_dollar": 4139.36, "additional_payer_notes": "212.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1952.53, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "ALLY-ALIGN (FKA SPARTAN PLAN NJ, INC.)", "plan_name": "ALLY-ALIGN (FKA SPARTAN PLAN NJ, INC.)", "methodology": "fee schedule", "standard_charge_dollar": 2050.16, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Americhoice (UHC)", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1952.53, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Amerihealth", "plan_name": "Amerihealth Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1952.53, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 2869.24, "additional_payer_notes": "146.95% of Medicare Rates" }, { "payer_name": "Clover Health", "plan_name": "Clover Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1952.53, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Coventry", "plan_name": "Coventry Auto", "methodology": "fee schedule", "standard_charge_dollar": 3905.06, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Coventry", "plan_name": "Coventry Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 3905.06, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "fee schedule", "standard_charge_dollar": 2733.54, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Fairprice Healthcare Holdings", "plan_name": "Fairprice Healthcare Holdings", "methodology": "fee schedule", "standard_charge_dollar": 3124.05, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ HMO POS", "methodology": "fee schedule", "standard_charge_dollar": 3461.84, "additional_payer_notes": "177.30% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ Indemnity", "methodology": "fee schedule", "standard_charge_dollar": 3461.84, "additional_payer_notes": "177.30% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ PPO", "methodology": "fee schedule", "standard_charge_dollar": 3461.84, "additional_payer_notes": "177.30% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1952.53, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Military Tricare", "methodology": "fee schedule", "standard_charge_dollar": 1562.02, "additional_payer_notes": "80.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1952.53, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 1952.53, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC All Payer (02-01-2023 to 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 3912.0 }, { "payer_name": "UHC", "plan_name": "UHC Oxford (02-01-2023 to 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 3676.0 }, { "payer_name": "UHC - Adhoc", "plan_name": "UHC - Adhoc All Payer", "methodology": "case rate", "standard_charge_dollar": 4153.0 }, { "payer_name": "UHC - Adhoc", "plan_name": "UHC - Adhoc Oxford", "methodology": "case rate", "standard_charge_dollar": 3788.0 }, { "payer_name": "Wellcare", "plan_name": "Wellcare Insurance Exchange", "methodology": "fee schedule", "standard_charge_dollar": 2635.92, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1952.53, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellchoice", "plan_name": "WELLCHOICE HMO of NJ (Empire) Commercial (HMO / HMO POS, PPO)", "methodology": "case rate", "standard_charge_dollar": 1715.0 }, { "payer_name": "Wellchoice", "plan_name": "WELLCHOICE HMO of NJ (Empire) Commercial (Indemnity)", "methodology": "case rate", "standard_charge_dollar": 1978.0 }, { "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1952.53, "additional_payer_notes": "100.00% of Medicare Rates" } ] } ] }, { "description": "Hc Rmvl Prm Epicar Pm&Eltrds Thorcom 1 Lead Sys", "code_information": [ { "code": "33236", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 1800.0, "minimum": 343.62, "maximum": 1800.0, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 821.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC All Payer (02-01-2023 to 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 1800.0 }, { "payer_name": "UHC", "plan_name": "UHC Oxford (02-01-2023 to 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 1800.0 }, { "payer_name": "UHC - Adhoc", "plan_name": "UHC - Adhoc All Payer", "methodology": "case rate", "standard_charge_dollar": 1800.0 }, { "payer_name": "UHC - Adhoc", "plan_name": "UHC - Adhoc Oxford", "methodology": "case rate", "standard_charge_dollar": 1800.0 }, { "payer_name": "Wellchoice", "plan_name": "WELLCHOICE HMO of NJ (Empire) Commercial (HMO / HMO POS, PPO)", "methodology": "case rate", "standard_charge_dollar": 1715.0 }, { "payer_name": "Wellchoice", "plan_name": "WELLCHOICE HMO of NJ (Empire) Commercial (Indemnity)", "methodology": "case rate", "standard_charge_dollar": 1800.0 } ] } ] }, { "description": "CARDIAC PACEMAKER & DEFIBRILLATOR REVISION EXCEPT DEVICE REPLACEMENT - SOI : 2", "code_information": [ { "code": "1772", "type": "APR-DRG" } ], "standard_charges": [ { "setting": "inpatient", "minimum": 21336.01, "maximum": 23469.61, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Better Health - Medi Medi", "methodology": "case rate", "standard_charge_dollar": 23469.61, "additional_payer_notes": "110% of State Medicaid Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Better Health Medicaid", "methodology": "case rate", "standard_charge_dollar": 23469.61, "additional_payer_notes": "110% of State Medicaid Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "case rate", "standard_charge_dollar": 21336.01, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "UBH", "plan_name": "UBH Medicaid", "methodology": "case rate", "standard_charge_dollar": 21336.01, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicaid (02/01/2023 to 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 21762.73, "additional_payer_notes": "102% of State Medicaid Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicaid", "methodology": "case rate", "standard_charge_dollar": 21336.01, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup Medicaid", "methodology": "case rate", "standard_charge_dollar": 21336.01, "additional_payer_notes": "100% of State Medicaid Rates" } ] } ] }, { "description": "PELVIC EVISCERATION, RADICAL HYSTERECTOMY AND RADICAL VULVECTOMY WITHOUT CCMCC", "code_information": [ { "code": "735", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 17105.0, "minimum": 8523.52, "maximum": 30961.7695, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "case rate", "standard_charge_dollar": 30961.77, "additional_payer_notes": "181.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medical Rental Network", "methodology": "case rate", "standard_charge_dollar": 30961.77, "additional_payer_notes": "181.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "case rate", "standard_charge_dollar": 14042.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "ALLY-ALIGN (FKA SPARTAN PLAN NJ, INC.)", "plan_name": "ALLY-ALIGN (FKA SPARTAN PLAN NJ, INC.)", "methodology": "case rate", "standard_charge_dollar": 17961.25, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Americhoice (UHC)", "plan_name": "UHC Medicare", "methodology": "case rate", "standard_charge_dollar": 14042.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Amerihealth", "plan_name": "Amerihealth Medicare", "methodology": "case rate", "standard_charge_dollar": 14042.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Commercial", "methodology": "case rate", "standard_charge_dollar": 19684.67 }, { "payer_name": "Clover Health", "plan_name": "Clover Medicare", "methodology": "case rate", "standard_charge_dollar": 14042.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Coventry", "plan_name": "Coventry Auto", "methodology": "case rate", "standard_charge_dollar": 29080.12, "additional_payer_notes": "170.00% of Medicare Rates" }, { "payer_name": "Coventry", "plan_name": "Coventry Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 29080.12, "additional_payer_notes": "170.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "case rate", "standard_charge_dollar": 22237.74, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Fairprice Healthcare Holdings", "plan_name": "Fairprice Healthcare Holdings", "methodology": "case rate", "standard_charge_dollar": 27369.52, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon Medicare", "methodology": "case rate", "standard_charge_dollar": 14042.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon NJ Health Medicaid", "methodology": "case rate", "standard_charge_dollar": 8523.52 }, { "payer_name": "Humana", "plan_name": "Humana Military Tricare", "methodology": "case rate", "standard_charge_dollar": 13684.76, "additional_payer_notes": "80.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 17105.95, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 17660.5 }, { "payer_name": "UBH", "plan_name": "UBH Medicare", "methodology": "case rate", "standard_charge_dollar": 14042.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC All Payer (02-01-2023 to 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 22679.75 }, { "payer_name": "UHC", "plan_name": "UHC Oxford (02-01-2023 to 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 19765.4 }, { "payer_name": "UHC - Adhoc", "plan_name": "UHC - Adhoc All Payer", "methodology": "case rate", "standard_charge_dollar": 24075.03 }, { "payer_name": "UHC - Adhoc", "plan_name": "UHC - Adhoc Oxford", "methodology": "case rate", "standard_charge_dollar": 20368.18 }, { "payer_name": "Wellcare", "plan_name": "Wellcare Insurance Exchange", "methodology": "case rate", "standard_charge_dollar": 23093.03, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "case rate", "standard_charge_dollar": 14042.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup Medicare", "methodology": "case rate", "standard_charge_dollar": 14042.3, "additional_payer_notes": "100.00% of Medicare Rates" } ] } ] }, { "description": "Hc Mediastinoscopy Includes Mediastinal Mass Biopsy", "code_information": [ { "code": "39401", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 1000.0, "discounted_cash": 7147.0, "minimum": 190.9, "maximum": 1000.0, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 1000.0, "additional_payer_notes": "212.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medical Rental Network", "methodology": "fee schedule", "standard_charge_dollar": 1000.0, "additional_payer_notes": "212.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1000.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "ALLY-ALIGN (FKA SPARTAN PLAN NJ, INC.)", "plan_name": "ALLY-ALIGN (FKA SPARTAN PLAN NJ, INC.)", "methodology": "fee schedule", "standard_charge_dollar": 1000.0, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Americhoice (UHC)", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1000.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Amerihealth", "plan_name": "Amerihealth Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1000.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 1000.0, "additional_payer_notes": "146.95% of Medicare Rates" }, { "payer_name": "Clover Health", "plan_name": "Clover Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1000.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Coventry", "plan_name": "Coventry Auto", "methodology": "fee schedule", "standard_charge_dollar": 1000.0, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Coventry", "plan_name": "Coventry Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 1000.0, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "fee schedule", "standard_charge_dollar": 1000.0, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Fairprice Healthcare Holdings", "plan_name": "Fairprice Healthcare Holdings", "methodology": "fee schedule", "standard_charge_dollar": 1000.0, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ HMO POS", "methodology": "fee schedule", "standard_charge_dollar": 1000.0, "additional_payer_notes": "177.30% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ Indemnity", "methodology": "fee schedule", "standard_charge_dollar": 1000.0, "additional_payer_notes": "177.30% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ PPO", "methodology": "fee schedule", "standard_charge_dollar": 1000.0, "additional_payer_notes": "177.30% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1000.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Military Tricare", "methodology": "fee schedule", "standard_charge_dollar": 1000.0, "additional_payer_notes": "80.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1000.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 1000.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC All Payer (02-01-2023 to 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 1000.0 }, { "payer_name": "UHC", "plan_name": "UHC Oxford (02-01-2023 to 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 1000.0 }, { "payer_name": "UHC - Adhoc", "plan_name": "UHC - Adhoc All Payer", "methodology": "case rate", "standard_charge_dollar": 1000.0 }, { "payer_name": "UHC - Adhoc", "plan_name": "UHC - Adhoc Oxford", "methodology": "case rate", "standard_charge_dollar": 1000.0 }, { "payer_name": "Wellcare", "plan_name": "Wellcare Insurance Exchange", "methodology": "fee schedule", "standard_charge_dollar": 1000.0, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1000.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellchoice", "plan_name": "WELLCHOICE HMO of NJ (Empire) Commercial (HMO / HMO POS, PPO)", "methodology": "case rate", "standard_charge_dollar": 1000.0 }, { "payer_name": "Wellchoice", "plan_name": "WELLCHOICE HMO of NJ (Empire) Commercial (Indemnity)", "methodology": "case rate", "standard_charge_dollar": 1000.0 }, { "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1000.0, "additional_payer_notes": "100.00% of Medicare Rates" } ] } ] }, { "description": "Hc Surg Path,Level Ii", "code_information": [ { "code": "88302", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 233.0, "discounted_cash": 44.0, "minimum": 13.79, "maximum": 198.05, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 93.6, "additional_payer_notes": "212.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medical Rental Network", "methodology": "fee schedule", "standard_charge_dollar": 93.6, "additional_payer_notes": "212.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 44.15, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "ALLY-ALIGN (FKA SPARTAN PLAN NJ, INC.)", "plan_name": "ALLY-ALIGN (FKA SPARTAN PLAN NJ, INC.)", "methodology": "fee schedule", "standard_charge_dollar": 46.36, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Americhoice (UHC)", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 44.15, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Amerihealth", "plan_name": "Amerihealth Medicare", "methodology": "fee schedule", "standard_charge_dollar": 44.15, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 64.88, "additional_payer_notes": "146.95% of Medicare Rates" }, { "payer_name": "Clover Health", "plan_name": "Clover Medicare", "methodology": "fee schedule", "standard_charge_dollar": 44.15, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Coventry", "plan_name": "Coventry Auto", "methodology": "fee schedule", "standard_charge_dollar": 88.3, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Coventry", "plan_name": "Coventry Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 88.3, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "fee schedule", "standard_charge_dollar": 61.81, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Fairprice Healthcare Holdings", "plan_name": "Fairprice Healthcare Holdings", "methodology": "fee schedule", "standard_charge_dollar": 70.64, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ HMO POS", "methodology": "fee schedule", "standard_charge_dollar": 78.28, "additional_payer_notes": "177.30% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ Indemnity", "methodology": "fee schedule", "standard_charge_dollar": 78.28, "additional_payer_notes": "177.30% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ PPO", "methodology": "fee schedule", "standard_charge_dollar": 78.28, "additional_payer_notes": "177.30% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon Medicare", "methodology": "fee schedule", "standard_charge_dollar": 44.15, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon NJ Health Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 27.3 }, { "payer_name": "Humana", "plan_name": "Humana Military Tricare", "methodology": "fee schedule", "standard_charge_dollar": 35.32, "additional_payer_notes": "80.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 44.15, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 44.15, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC All Payer (02-01-2023 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 13.79 }, { "payer_name": "UHC", "plan_name": "UHC Medicaid (02/01/2023 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 27.3 }, { "payer_name": "UHC", "plan_name": "UHC Oxford (02-01-2023 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 13.79 }, { "payer_name": "UHC - Adhoc", "plan_name": "UHC - Adhoc All Payer", "methodology": "fee schedule", "standard_charge_dollar": 22.99 }, { "payer_name": "UHC - Adhoc", "plan_name": "UHC - Adhoc Oxford", "methodology": "fee schedule", "standard_charge_dollar": 22.99 }, { "payer_name": "Wellcare", "plan_name": "Wellcare Insurance Exchange", "methodology": "fee schedule", "standard_charge_dollar": 59.6, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 44.15, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup Medicaid", "methodology": "percent of total billed charges", "standard_charge_percentage": 19.09, "median_amount": 43.45, "10th_percentile": 43.45, "90th_percentile": 44.48, "count": "1 through 10" }, { "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup Medicare", "methodology": "fee schedule", "standard_charge_dollar": 44.15, "additional_payer_notes": "100.00% of Medicare Rates" } ] } ] }, { "description": "OTHER PNEUMONIA - SOI : 1", "code_information": [ { "code": "1391", "type": "APR-DRG" } ], "standard_charges": [ { "setting": "inpatient", "minimum": 5736.15, "maximum": 6309.77, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Better Health - Medi Medi", "methodology": "case rate", "standard_charge_dollar": 6309.77, "additional_payer_notes": "110% of State Medicaid Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Better Health Medicaid", "methodology": "case rate", "standard_charge_dollar": 6309.77, "additional_payer_notes": "110% of State Medicaid Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "case rate", "standard_charge_dollar": 5736.15, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "UBH", "plan_name": "UBH Medicaid", "methodology": "case rate", "standard_charge_dollar": 5736.15, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicaid (02/01/2023 to 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 5850.88, "additional_payer_notes": "102% of State Medicaid Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicaid", "methodology": "case rate", "standard_charge_dollar": 5736.15, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup Medicaid", "methodology": "case rate", "standard_charge_dollar": 5736.15, "additional_payer_notes": "100% of State Medicaid Rates" } ] } ] }, { "description": "OTHER SKIN, SUBCUTANEOUS TISSUE & BREAST DISORDERS - SOI : 2", "code_information": [ { "code": "3852", "type": "APR-DRG" } ], "standard_charges": [ { "setting": "inpatient", "minimum": 7187.62, "maximum": 7906.38, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Better Health - Medi Medi", "methodology": "case rate", "standard_charge_dollar": 7906.38, "additional_payer_notes": "110% of State Medicaid Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Better Health Medicaid", "methodology": "case rate", "standard_charge_dollar": 7906.38, "additional_payer_notes": "110% of State Medicaid Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "case rate", "standard_charge_dollar": 7187.62, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "UBH", "plan_name": "UBH Medicaid", "methodology": "case rate", "standard_charge_dollar": 7187.62, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicaid (02/01/2023 to 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 7331.37, "additional_payer_notes": "102% of State Medicaid Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicaid", "methodology": "case rate", "standard_charge_dollar": 7187.62, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup Medicaid", "methodology": "case rate", "standard_charge_dollar": 7187.62, "additional_payer_notes": "100% of State Medicaid Rates" } ] } ] }, { "description": "Hc Prq Trluml Coronary Stent W/Angio One Art/Brnch - 92928 - 48100127", "code_information": [ { "code": "92928", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 48345.2, "discounted_cash": 13647.0, "minimum": 2472.0, "maximum": 38676.16, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 28932.91, "additional_payer_notes": "212.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medical Rental Network", "methodology": "fee schedule", "standard_charge_dollar": 28932.91, "additional_payer_notes": "212.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 13647.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "ALLY-ALIGN (FKA SPARTAN PLAN NJ, INC.)", "plan_name": "ALLY-ALIGN (FKA SPARTAN PLAN NJ, INC.)", "methodology": "fee schedule", "standard_charge_dollar": 14329.98, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Americhoice (UHC)", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 13647.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Amerihealth", "plan_name": "Amerihealth Medicare", "methodology": "fee schedule", "standard_charge_dollar": 13647.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 20055.15, "additional_payer_notes": "146.95% of Medicare Rates" }, { "payer_name": "Clover Health", "plan_name": "Clover Medicare", "methodology": "fee schedule", "standard_charge_dollar": 13647.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Coventry", "plan_name": "Coventry Auto", "methodology": "fee schedule", "standard_charge_dollar": 27295.2, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Coventry", "plan_name": "Coventry Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 27295.2, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "fee schedule", "standard_charge_dollar": 19106.64, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Fairprice Healthcare Holdings", "plan_name": "Fairprice Healthcare Holdings", "methodology": "fee schedule", "standard_charge_dollar": 21836.16, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ HMO POS", "methodology": "fee schedule", "standard_charge_dollar": 24197.19, "additional_payer_notes": "177.30% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ Indemnity", "methodology": "fee schedule", "standard_charge_dollar": 24197.19, "additional_payer_notes": "177.30% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ PPO", "methodology": "fee schedule", "standard_charge_dollar": 24197.19, "additional_payer_notes": "177.30% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon Medicare", "methodology": "fee schedule", "standard_charge_dollar": 13647.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Military Tricare", "methodology": "fee schedule", "standard_charge_dollar": 10918.08, "additional_payer_notes": "80.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 13647.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 13647.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC All Payer (02-01-2023 to 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 6624.0 }, { "payer_name": "UHC", "plan_name": "UHC Oxford (02-01-2023 to 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 6317.0 }, { "payer_name": "UHC - Adhoc", "plan_name": "UHC - Adhoc All Payer", "methodology": "case rate", "standard_charge_dollar": 7031.0 }, { "payer_name": "UHC - Adhoc", "plan_name": "UHC - Adhoc Oxford", "methodology": "case rate", "standard_charge_dollar": 6510.0 }, { "payer_name": "Wellcare", "plan_name": "Wellcare Insurance Exchange", "methodology": "fee schedule", "standard_charge_dollar": 18424.26, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 13647.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellchoice", "plan_name": "WELLCHOICE HMO of NJ (Empire) Commercial (HMO / HMO POS, PPO)", "methodology": "case rate", "standard_charge_dollar": 2472.0 }, { "payer_name": "Wellchoice", "plan_name": "WELLCHOICE HMO of NJ (Empire) Commercial (Indemnity)", "methodology": "case rate", "standard_charge_dollar": 2753.0 }, { "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup Medicare", "methodology": "fee schedule", "standard_charge_dollar": 13647.6, "additional_payer_notes": "100.00% of Medicare Rates" } ] } ] }, { "description": "Hc Test For Urine Cystines", "code_information": [ { "code": "82615", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 43.0, "discounted_cash": 9.0, "minimum": 5.73, "maximum": 36.55, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 20.25, "additional_payer_notes": "212.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medical Rental Network", "methodology": "fee schedule", "standard_charge_dollar": 20.25, "additional_payer_notes": "212.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 9.55, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "ALLY-ALIGN (FKA SPARTAN PLAN NJ, INC.)", "plan_name": "ALLY-ALIGN (FKA SPARTAN PLAN NJ, INC.)", "methodology": "fee schedule", "standard_charge_dollar": 10.03, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Americhoice (UHC)", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 9.55, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Amerihealth", "plan_name": "Amerihealth Medicare", "methodology": "fee schedule", "standard_charge_dollar": 9.55, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 13.85, "additional_payer_notes": "Laboratory - 145.00% of Medicare Rates" }, { "payer_name": "Clover Health", "plan_name": "Clover Medicare", "methodology": "fee schedule", "standard_charge_dollar": 9.55, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Coventry", "plan_name": "Coventry Auto", "methodology": "fee schedule", "standard_charge_dollar": 19.1, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Coventry", "plan_name": "Coventry Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 19.1, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "fee schedule", "standard_charge_dollar": 13.37, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Fairprice Healthcare Holdings", "plan_name": "Fairprice Healthcare Holdings", "methodology": "fee schedule", "standard_charge_dollar": 11.46, "additional_payer_notes": "Laboratory - 120.00% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ HMO POS", "methodology": "fee schedule", "standard_charge_dollar": 30.36, "additional_payer_notes": "177.30% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ Indemnity", "methodology": "fee schedule", "standard_charge_dollar": 30.36, "additional_payer_notes": "177.30% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ PPO", "methodology": "fee schedule", "standard_charge_dollar": 30.36, "additional_payer_notes": "177.30% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon Medicare", "methodology": "fee schedule", "standard_charge_dollar": 9.55, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Military Tricare", "methodology": "fee schedule", "standard_charge_dollar": 7.64, "additional_payer_notes": "80.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 9.55, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 9.55, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC All Payer (02-01-2023 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 5.73 }, { "payer_name": "UHC", "plan_name": "UHC Medicaid (02/01/2023 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 7.64 }, { "payer_name": "UHC", "plan_name": "UHC Oxford (02-01-2023 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 5.73 }, { "payer_name": "UHC - Adhoc", "plan_name": "UHC - Adhoc All Payer", "methodology": "fee schedule", "standard_charge_dollar": 9.55 }, { "payer_name": "UHC - Adhoc", "plan_name": "UHC - Adhoc Oxford", "methodology": "fee schedule", "standard_charge_dollar": 9.55 }, { "payer_name": "Wellcare", "plan_name": "Wellcare Insurance Exchange", "methodology": "fee schedule", "standard_charge_dollar": 12.89, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 9.55, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup Medicare", "methodology": "fee schedule", "standard_charge_dollar": 9.55, "additional_payer_notes": "100.00% of Medicare Rates" } ] } ] }, { "description": "Hc Clsd Treat Radioulna Disloc W Manip", "code_information": [ { "code": "25675", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 839.01, "discounted_cash": 291.0, "minimum": 160.167, "maximum": 839.01, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 618.19, "additional_payer_notes": "212.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medical Rental Network", "methodology": "fee schedule", "standard_charge_dollar": 618.19, "additional_payer_notes": "212.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 291.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "ALLY-ALIGN (FKA SPARTAN PLAN NJ, INC.)", "plan_name": "ALLY-ALIGN (FKA SPARTAN PLAN NJ, INC.)", "methodology": "fee schedule", "standard_charge_dollar": 306.18, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Americhoice (UHC)", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 291.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Amerihealth", "plan_name": "Amerihealth Medicare", "methodology": "fee schedule", "standard_charge_dollar": 291.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 428.51, "additional_payer_notes": "146.95% of Medicare Rates" }, { "payer_name": "Clover Health", "plan_name": "Clover Medicare", "methodology": "fee schedule", "standard_charge_dollar": 291.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Coventry", "plan_name": "Coventry Auto", "methodology": "fee schedule", "standard_charge_dollar": 583.2, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Coventry", "plan_name": "Coventry Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 583.2, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "fee schedule", "standard_charge_dollar": 408.24, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Fairprice Healthcare Holdings", "plan_name": "Fairprice Healthcare Holdings", "methodology": "fee schedule", "standard_charge_dollar": 466.56, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ HMO POS", "methodology": "fee schedule", "standard_charge_dollar": 517.01, "additional_payer_notes": "177.30% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ Indemnity", "methodology": "fee schedule", "standard_charge_dollar": 517.01, "additional_payer_notes": "177.30% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ PPO", "methodology": "fee schedule", "standard_charge_dollar": 517.01, "additional_payer_notes": "177.30% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon Medicare", "methodology": "fee schedule", "standard_charge_dollar": 291.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Military Tricare", "methodology": "fee schedule", "standard_charge_dollar": 233.28, "additional_payer_notes": "80.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 291.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 291.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC All Payer (02-01-2023 to 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 839.01 }, { "payer_name": "UHC", "plan_name": "UHC Oxford (02-01-2023 to 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 839.01 }, { "payer_name": "UHC - Adhoc", "plan_name": "UHC - Adhoc All Payer", "methodology": "case rate", "standard_charge_dollar": 839.01 }, { "payer_name": "UHC - Adhoc", "plan_name": "UHC - Adhoc Oxford", "methodology": "case rate", "standard_charge_dollar": 839.01 }, { "payer_name": "Wellcare", "plan_name": "Wellcare Insurance Exchange", "methodology": "fee schedule", "standard_charge_dollar": 393.66, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 291.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup Medicare", "methodology": "fee schedule", "standard_charge_dollar": 291.6, "additional_payer_notes": "100.00% of Medicare Rates" } ] } ] }, { "description": "OTHER DRUG ABUSE & DEPENDENCE - SOI : 1", "code_information": [ { "code": "7761", "type": "APR-DRG" } ], "standard_charges": [ { "setting": "inpatient", "minimum": 4707.51, "maximum": 5178.26, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Better Health - Medi Medi", "methodology": "case rate", "standard_charge_dollar": 5178.26, "additional_payer_notes": "110% of State Medicaid Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Better Health Medicaid", "methodology": "case rate", "standard_charge_dollar": 5178.26, "additional_payer_notes": "110% of State Medicaid Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "case rate", "standard_charge_dollar": 4707.51, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "UBH", "plan_name": "UBH Medicaid", "methodology": "case rate", "standard_charge_dollar": 4707.51, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicaid (02/01/2023 to 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 4801.66, "additional_payer_notes": "102% of State Medicaid Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicaid", "methodology": "case rate", "standard_charge_dollar": 4707.51, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup Medicaid", "methodology": "case rate", "standard_charge_dollar": 4707.51, "additional_payer_notes": "100% of State Medicaid Rates" } ] } ] }, { "description": "HIV WITH OR WITHOUT OTHER RELATED CONDITION", "code_information": [ { "code": "977", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 16553.0, "minimum": 7305.25, "maximum": 29961.9255, "payers_information": [ { "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup Medicare", "methodology": "case rate", "standard_charge_dollar": 13598.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "case rate", "standard_charge_dollar": 29961.93, "additional_payer_notes": "181.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medical Rental Network", "methodology": "case rate", "standard_charge_dollar": 29961.93, "additional_payer_notes": "181.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "case rate", "standard_charge_dollar": 13598.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "ALLY-ALIGN (FKA SPARTAN PLAN NJ, INC.)", "plan_name": "ALLY-ALIGN (FKA SPARTAN PLAN NJ, INC.)", "methodology": "case rate", "standard_charge_dollar": 17381.23, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Americhoice (UHC)", "plan_name": "UHC Medicare", "methodology": "case rate", "standard_charge_dollar": 13598.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Amerihealth", "plan_name": "Amerihealth Medicare", "methodology": "case rate", "standard_charge_dollar": 13598.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Commercial", "methodology": "case rate", "standard_charge_dollar": 18985.35 }, { "payer_name": "Clover Health", "plan_name": "Clover Medicare", "methodology": "case rate", "standard_charge_dollar": 13598.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Coventry", "plan_name": "Coventry Auto", "methodology": "case rate", "standard_charge_dollar": 28141.04, "additional_payer_notes": "170.00% of Medicare Rates" }, { "payer_name": "Coventry", "plan_name": "Coventry Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 28141.04, "additional_payer_notes": "170.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "case rate", "standard_charge_dollar": 21519.62, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Fairprice Healthcare Holdings", "plan_name": "Fairprice Healthcare Holdings", "methodology": "case rate", "standard_charge_dollar": 26485.68, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon Medicare", "methodology": "case rate", "standard_charge_dollar": 13598.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon NJ Health Medicaid", "methodology": "case rate", "standard_charge_dollar": 7305.25 }, { "payer_name": "Humana", "plan_name": "Humana Military Tricare", "methodology": "case rate", "standard_charge_dollar": 13242.84, "additional_payer_notes": "80.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 16553.55, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 20977.9 }, { "payer_name": "UBH", "plan_name": "UBH Medicare", "methodology": "case rate", "standard_charge_dollar": 13598.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC All Payer (02-01-2023 to 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 21874.03 }, { "payer_name": "UHC", "plan_name": "UHC Oxford (02-01-2023 to 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 19063.21 }, { "payer_name": "UHC - Adhoc", "plan_name": "UHC - Adhoc All Payer", "methodology": "case rate", "standard_charge_dollar": 23219.75 }, { "payer_name": "UHC - Adhoc", "plan_name": "UHC - Adhoc Oxford", "methodology": "case rate", "standard_charge_dollar": 19644.58 }, { "payer_name": "Wellcare", "plan_name": "Wellcare Insurance Exchange", "methodology": "case rate", "standard_charge_dollar": 22347.29, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "case rate", "standard_charge_dollar": 13598.8, "additional_payer_notes": "100.00% of Medicare Rates" } ] } ] }, { "description": "BRAIN CONTUSIONLACERATION & COMPLICATED SKULL FX, COMA < 1 HR OR NO COMA - SOI : 3", "code_information": [ { "code": "0563", "type": "APR-DRG" } ], "standard_charges": [ { "setting": "inpatient", "minimum": 15144.83, "maximum": 16659.32, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Better Health - Medi Medi", "methodology": "case rate", "standard_charge_dollar": 16659.32, "additional_payer_notes": "110% of State Medicaid Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Better Health Medicaid", "methodology": "case rate", "standard_charge_dollar": 16659.32, "additional_payer_notes": "110% of State Medicaid Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "case rate", "standard_charge_dollar": 15144.83, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "UBH", "plan_name": "UBH Medicaid", "methodology": "case rate", "standard_charge_dollar": 15144.83, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicaid (02/01/2023 to 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 15447.73, "additional_payer_notes": "102% of State Medicaid Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicaid", "methodology": "case rate", "standard_charge_dollar": 15144.83, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup Medicaid", "methodology": "case rate", "standard_charge_dollar": 15144.83, "additional_payer_notes": "100% of State Medicaid Rates" } ] } ] }, { "description": "Hc Cytopath,Othr Sourc,Prep,Scrn,Interp", "code_information": [ { "code": "88161", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 116.0, "discounted_cash": 34.0, "minimum": 13.79, "maximum": 98.6, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 72.48, "additional_payer_notes": "212.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medical Rental Network", "methodology": "fee schedule", "standard_charge_dollar": 72.48, "additional_payer_notes": "212.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 34.19, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "ALLY-ALIGN (FKA SPARTAN PLAN NJ, INC.)", "plan_name": "ALLY-ALIGN (FKA SPARTAN PLAN NJ, INC.)", "methodology": "fee schedule", "standard_charge_dollar": 35.9, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Americhoice (UHC)", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 34.19, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Amerihealth", "plan_name": "Amerihealth Medicare", "methodology": "fee schedule", "standard_charge_dollar": 34.19, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 50.24, "additional_payer_notes": "146.95% of Medicare Rates" }, { "payer_name": "Clover Health", "plan_name": "Clover Medicare", "methodology": "fee schedule", "standard_charge_dollar": 34.19, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Coventry", "plan_name": "Coventry Auto", "methodology": "fee schedule", "standard_charge_dollar": 68.38, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Coventry", "plan_name": "Coventry Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 68.38, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "fee schedule", "standard_charge_dollar": 47.87, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Fairprice Healthcare Holdings", "plan_name": "Fairprice Healthcare Holdings", "methodology": "fee schedule", "standard_charge_dollar": 54.7, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ HMO POS", "methodology": "fee schedule", "standard_charge_dollar": 60.62, "additional_payer_notes": "177.30% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ Indemnity", "methodology": "fee schedule", "standard_charge_dollar": 60.62, "additional_payer_notes": "177.30% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ PPO", "methodology": "fee schedule", "standard_charge_dollar": 60.62, "additional_payer_notes": "177.30% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon Medicare", "methodology": "fee schedule", "standard_charge_dollar": 34.19, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon NJ Health Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 66.34 }, { "payer_name": "Humana", "plan_name": "Humana Military Tricare", "methodology": "fee schedule", "standard_charge_dollar": 27.35, "additional_payer_notes": "80.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 34.19, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 34.19, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC All Payer (02-01-2023 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 13.79 }, { "payer_name": "UHC", "plan_name": "UHC Medicaid (02/01/2023 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 66.34 }, { "payer_name": "UHC", "plan_name": "UHC Oxford (02-01-2023 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 13.79 }, { "payer_name": "UHC - Adhoc", "plan_name": "UHC - Adhoc All Payer", "methodology": "fee schedule", "standard_charge_dollar": 22.99 }, { "payer_name": "UHC - Adhoc", "plan_name": "UHC - Adhoc Oxford", "methodology": "fee schedule", "standard_charge_dollar": 22.99 }, { "payer_name": "Wellcare", "plan_name": "Wellcare Insurance Exchange", "methodology": "fee schedule", "standard_charge_dollar": 46.16, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 34.19, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup Medicare", "methodology": "fee schedule", "standard_charge_dollar": 34.19, "additional_payer_notes": "100.00% of Medicare Rates" } ] } ] }, { "description": "Reconstruct ankle joint", "code_information": [ { "code": "27702", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 49776.26, "discounted_cash": 32077.0, "minimum": 1715.0, "maximum": 49776.26, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 49776.26, "additional_payer_notes": "212.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medical Rental Network", "methodology": "fee schedule", "standard_charge_dollar": 49776.26, "additional_payer_notes": "212.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 32077.97, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "ALLY-ALIGN (FKA SPARTAN PLAN NJ, INC.)", "plan_name": "ALLY-ALIGN (FKA SPARTAN PLAN NJ, INC.)", "methodology": "fee schedule", "standard_charge_dollar": 33681.87, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Americhoice (UHC)", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 32077.97, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Amerihealth", "plan_name": "Amerihealth Medicare", "methodology": "fee schedule", "standard_charge_dollar": 32077.97, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 47138.58, "additional_payer_notes": "146.95% of Medicare Rates" }, { "payer_name": "Clover Health", "plan_name": "Clover Medicare", "methodology": "fee schedule", "standard_charge_dollar": 32077.97, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Coventry", "plan_name": "Coventry Auto", "methodology": "fee schedule", "standard_charge_dollar": 49776.26, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Coventry", "plan_name": "Coventry Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 49776.26, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "fee schedule", "standard_charge_dollar": 44909.16, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Fairprice Healthcare Holdings", "plan_name": "Fairprice Healthcare Holdings", "methodology": "fee schedule", "standard_charge_dollar": 49776.26, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ HMO POS", "methodology": "fee schedule", "standard_charge_dollar": 49776.26, "additional_payer_notes": "177.30% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ Indemnity", "methodology": "fee schedule", "standard_charge_dollar": 49776.26, "additional_payer_notes": "177.30% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ PPO", "methodology": "fee schedule", "standard_charge_dollar": 49776.26, "additional_payer_notes": "177.30% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon Medicare", "methodology": "fee schedule", "standard_charge_dollar": 32077.97, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Military Tricare", "methodology": "fee schedule", "standard_charge_dollar": 25662.38, "additional_payer_notes": "80.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 32077.97, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 32077.97, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC All Payer (02-01-2023 to 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 6624.0 }, { "payer_name": "UHC", "plan_name": "UHC Oxford (02-01-2023 to 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 6317.0 }, { "payer_name": "UHC - Adhoc", "plan_name": "UHC - Adhoc All Payer", "methodology": "case rate", "standard_charge_dollar": 7031.0 }, { "payer_name": "UHC - Adhoc", "plan_name": "UHC - Adhoc Oxford", "methodology": "case rate", "standard_charge_dollar": 6510.0 }, { "payer_name": "Wellcare", "plan_name": "Wellcare Insurance Exchange", "methodology": "fee schedule", "standard_charge_dollar": 43305.26, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 32077.97, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellchoice", "plan_name": "WELLCHOICE HMO of NJ (Empire) Commercial (HMO / HMO POS, PPO)", "methodology": "case rate", "standard_charge_dollar": 1715.0 }, { "payer_name": "Wellchoice", "plan_name": "WELLCHOICE HMO of NJ (Empire) Commercial (Indemnity)", "methodology": "case rate", "standard_charge_dollar": 1978.0 }, { "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup Medicare", "methodology": "fee schedule", "standard_charge_dollar": 32077.97, "additional_payer_notes": "100.00% of Medicare Rates" } ] } ] }, { "description": "BACTERIAL AND TUBERCULOUS INFECTIONS OF NERVOUS SYSTEM WITH MCC", "code_information": [ { "code": "094", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 42228.0, "minimum": 22966.04, "maximum": 76433.6936, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "case rate", "standard_charge_dollar": 76433.69, "additional_payer_notes": "181.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medical Rental Network", "methodology": "case rate", "standard_charge_dollar": 76433.69, "additional_payer_notes": "181.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "case rate", "standard_charge_dollar": 34215.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "ALLY-ALIGN (FKA SPARTAN PLAN NJ, INC.)", "plan_name": "ALLY-ALIGN (FKA SPARTAN PLAN NJ, INC.)", "methodology": "case rate", "standard_charge_dollar": 44339.99, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Americhoice (UHC)", "plan_name": "UHC Medicare", "methodology": "case rate", "standard_charge_dollar": 34215.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Amerihealth", "plan_name": "Amerihealth Medicare", "methodology": "case rate", "standard_charge_dollar": 34215.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Commercial", "methodology": "case rate", "standard_charge_dollar": 51488.82 }, { "payer_name": "Clover Health", "plan_name": "Clover Medicare", "methodology": "case rate", "standard_charge_dollar": 34215.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Coventry", "plan_name": "Coventry Auto", "methodology": "case rate", "standard_charge_dollar": 71788.55, "additional_payer_notes": "170.00% of Medicare Rates" }, { "payer_name": "Coventry", "plan_name": "Coventry Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 71788.55, "additional_payer_notes": "170.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "case rate", "standard_charge_dollar": 54897.13, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Fairprice Healthcare Holdings", "plan_name": "Fairprice Healthcare Holdings", "methodology": "case rate", "standard_charge_dollar": 67565.7, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon Medicare", "methodology": "case rate", "standard_charge_dollar": 34215.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon NJ Health Medicaid", "methodology": "case rate", "standard_charge_dollar": 22966.04 }, { "payer_name": "Humana", "plan_name": "Humana Military Tricare", "methodology": "case rate", "standard_charge_dollar": 33782.85, "additional_payer_notes": "80.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 42228.56, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 43250.8 }, { "payer_name": "UBH", "plan_name": "UBH Medicare", "methodology": "case rate", "standard_charge_dollar": 34215.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC All Payer (02-01-2023 to 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 59323.01 }, { "payer_name": "UHC", "plan_name": "UHC Oxford (02-01-2023 to 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 51699.99 }, { "payer_name": "UHC - Adhoc", "plan_name": "UHC - Adhoc All Payer", "methodology": "case rate", "standard_charge_dollar": 62972.62 }, { "payer_name": "UHC - Adhoc", "plan_name": "UHC - Adhoc Oxford", "methodology": "case rate", "standard_charge_dollar": 53276.68 }, { "payer_name": "Wellcare", "plan_name": "Wellcare Insurance Exchange", "methodology": "case rate", "standard_charge_dollar": 57008.56, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "case rate", "standard_charge_dollar": 34215.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup Medicare", "methodology": "case rate", "standard_charge_dollar": 34215.1, "additional_payer_notes": "100.00% of Medicare Rates" } ] } ] }, { "description": "Hc Inject Trigger Point1-2 Muscle", "code_information": [ { "code": "20552", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 922.46, "discounted_cash": 362.0, "minimum": 176.0976, "maximum": 922.46, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 769.28, "additional_payer_notes": "212.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medical Rental Network", "methodology": "fee schedule", "standard_charge_dollar": 769.28, "additional_payer_notes": "212.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 362.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "ALLY-ALIGN (FKA SPARTAN PLAN NJ, INC.)", "plan_name": "ALLY-ALIGN (FKA SPARTAN PLAN NJ, INC.)", "methodology": "fee schedule", "standard_charge_dollar": 381.01, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Americhoice (UHC)", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 362.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Amerihealth", "plan_name": "Amerihealth Medicare", "methodology": "fee schedule", "standard_charge_dollar": 362.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 533.24, "additional_payer_notes": "146.95% of Medicare Rates" }, { "payer_name": "Clover Health", "plan_name": "Clover Medicare", "methodology": "fee schedule", "standard_charge_dollar": 362.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Coventry", "plan_name": "Coventry Auto", "methodology": "fee schedule", "standard_charge_dollar": 725.74, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Coventry", "plan_name": "Coventry Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 725.74, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "fee schedule", "standard_charge_dollar": 508.02, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Fairprice Healthcare Holdings", "plan_name": "Fairprice Healthcare Holdings", "methodology": "fee schedule", "standard_charge_dollar": 580.59, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ HMO POS", "methodology": "fee schedule", "standard_charge_dollar": 643.37, "additional_payer_notes": "177.30% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ Indemnity", "methodology": "fee schedule", "standard_charge_dollar": 643.37, "additional_payer_notes": "177.30% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ PPO", "methodology": "fee schedule", "standard_charge_dollar": 643.37, "additional_payer_notes": "177.30% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon Medicare", "methodology": "fee schedule", "standard_charge_dollar": 362.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Military Tricare", "methodology": "fee schedule", "standard_charge_dollar": 290.3, "additional_payer_notes": "80.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 362.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 362.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC All Payer (02-01-2023 to 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 922.46 }, { "payer_name": "UHC", "plan_name": "UHC Oxford (02-01-2023 to 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 922.46 }, { "payer_name": "UHC - Adhoc", "plan_name": "UHC - Adhoc All Payer", "methodology": "case rate", "standard_charge_dollar": 922.46 }, { "payer_name": "UHC - Adhoc", "plan_name": "UHC - Adhoc Oxford", "methodology": "case rate", "standard_charge_dollar": 922.46 }, { "payer_name": "Wellcare", "plan_name": "Wellcare Insurance Exchange", "methodology": "fee schedule", "standard_charge_dollar": 489.87, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 362.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellchoice", "plan_name": "WELLCHOICE HMO of NJ (Empire) Commercial (HMO / HMO POS, PPO)", "methodology": "case rate", "standard_charge_dollar": 922.46 }, { "payer_name": "Wellchoice", "plan_name": "WELLCHOICE HMO of NJ (Empire) Commercial (Indemnity)", "methodology": "case rate", "standard_charge_dollar": 922.46 }, { "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup Medicare", "methodology": "fee schedule", "standard_charge_dollar": 362.87, "additional_payer_notes": "100.00% of Medicare Rates" } ] } ] }, { "description": "PERCUTANEOUS CARDIOVASCULAR PROCEDURES WITH INTRALUMINAL DEVICE WITHOUT MCC", "code_information": [ { "code": "322", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 21930.0, "minimum": 17544.624, "maximum": 39694.7118, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "case rate", "standard_charge_dollar": 39694.71, "additional_payer_notes": "181.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medical Rental Network", "methodology": "case rate", "standard_charge_dollar": 39694.71, "additional_payer_notes": "181.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "case rate", "standard_charge_dollar": 17916.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "ALLY-ALIGN (FKA SPARTAN PLAN NJ, INC.)", "plan_name": "ALLY-ALIGN (FKA SPARTAN PLAN NJ, INC.)", "methodology": "case rate", "standard_charge_dollar": 23027.32, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Americhoice (UHC)", "plan_name": "UHC Medicare", "methodology": "case rate", "standard_charge_dollar": 17916.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Amerihealth", "plan_name": "Amerihealth Medicare", "methodology": "case rate", "standard_charge_dollar": 17916.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Commercial", "methodology": "case rate", "standard_charge_dollar": 25792.69 }, { "payer_name": "Clover Health", "plan_name": "Clover Medicare", "methodology": "case rate", "standard_charge_dollar": 17916.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Coventry", "plan_name": "Coventry Auto", "methodology": "case rate", "standard_charge_dollar": 37282.33, "additional_payer_notes": "170.00% of Medicare Rates" }, { "payer_name": "Coventry", "plan_name": "Coventry Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 37282.33, "additional_payer_notes": "170.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "case rate", "standard_charge_dollar": 28510.01, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Fairprice Healthcare Holdings", "plan_name": "Fairprice Healthcare Holdings", "methodology": "case rate", "standard_charge_dollar": 35089.25, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon Medicare", "methodology": "case rate", "standard_charge_dollar": 17916.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Military Tricare", "methodology": "case rate", "standard_charge_dollar": 17544.62, "additional_payer_notes": "80.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 21930.78, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 32133.4 }, { "payer_name": "UBH", "plan_name": "UBH Medicare", "methodology": "case rate", "standard_charge_dollar": 17916.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC All Payer (02-01-2023 to 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 29717.13 }, { "payer_name": "UHC", "plan_name": "UHC Oxford (02-01-2023 to 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 25898.47 }, { "payer_name": "UHC - Adhoc", "plan_name": "UHC - Adhoc All Payer", "methodology": "case rate", "standard_charge_dollar": 31545.36 }, { "payer_name": "UHC - Adhoc", "plan_name": "UHC - Adhoc Oxford", "methodology": "case rate", "standard_charge_dollar": 26688.29 }, { "payer_name": "Wellcare", "plan_name": "Wellcare Insurance Exchange", "methodology": "case rate", "standard_charge_dollar": 29606.55, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "case rate", "standard_charge_dollar": 17916.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup Medicare", "methodology": "case rate", "standard_charge_dollar": 17916.5, "additional_payer_notes": "100.00% of Medicare Rates" } ] } ] }, { "description": "BPD & OTH CHRONIC RESPIRATORY DISEASES ARISING IN PERINATAL PERIOD - SOI : 3", "code_information": [ { "code": "1323", "type": "APR-DRG" } ], "standard_charges": [ { "setting": "inpatient", "minimum": 11224.89, "maximum": 12347.38, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Better Health - Medi Medi", "methodology": "case rate", "standard_charge_dollar": 12347.38, "additional_payer_notes": "110% of State Medicaid Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Better Health Medicaid", "methodology": "case rate", "standard_charge_dollar": 12347.38, "additional_payer_notes": "110% of State Medicaid Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "case rate", "standard_charge_dollar": 11224.89, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "UBH", "plan_name": "UBH Medicaid", "methodology": "case rate", "standard_charge_dollar": 11224.89, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicaid (02/01/2023 to 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 11449.39, "additional_payer_notes": "102% of State Medicaid Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicaid", "methodology": "case rate", "standard_charge_dollar": 11224.89, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup Medicaid", "methodology": "case rate", "standard_charge_dollar": 11224.89, "additional_payer_notes": "100% of State Medicaid Rates" } ] } ] }, { "description": "Hc Urinalysis Nonauto W/O Scope", "code_information": [ { "code": "81002", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 13.0, "discounted_cash": 3.0, "minimum": 2.09, "maximum": 11.05, "payers_information": [ { "payer_name": "UHC", "plan_name": "UHC Medicaid (02/01/2023 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 2.78 }, { "payer_name": "UHC", "plan_name": "UHC Oxford (02-01-2023 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 2.09 }, { "payer_name": "UHC - Adhoc", "plan_name": "UHC - Adhoc All Payer", "methodology": "fee schedule", "standard_charge_dollar": 3.48 }, { "payer_name": "UHC - Adhoc", "plan_name": "UHC - Adhoc Oxford", "methodology": "fee schedule", "standard_charge_dollar": 3.48 }, { "payer_name": "Wellcare", "plan_name": "Wellcare Insurance Exchange", "methodology": "fee schedule", "standard_charge_dollar": 4.7, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3.48, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup Medicaid", "methodology": "percent of total billed charges", "standard_charge_percentage": 19.09, "median_amount": 2.42, "10th_percentile": 2.42, "90th_percentile": 2.48, "count": "1 through 10" }, { "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3.48, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 7.38, "additional_payer_notes": "212.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medical Rental Network", "methodology": "fee schedule", "standard_charge_dollar": 7.38, "additional_payer_notes": "212.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3.48, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "ALLY-ALIGN (FKA SPARTAN PLAN NJ, INC.)", "plan_name": "ALLY-ALIGN (FKA SPARTAN PLAN NJ, INC.)", "methodology": "fee schedule", "standard_charge_dollar": 3.65, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Americhoice (UHC)", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3.48, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Amerihealth", "plan_name": "Amerihealth Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3.48, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 5.05, "additional_payer_notes": "Laboratory - 145.00% of Medicare Rates" }, { "payer_name": "Clover Health", "plan_name": "Clover Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3.48, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Coventry", "plan_name": "Coventry Auto", "methodology": "fee schedule", "standard_charge_dollar": 6.96, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Coventry", "plan_name": "Coventry Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 6.96, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "fee schedule", "standard_charge_dollar": 4.87, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Fairprice Healthcare Holdings", "plan_name": "Fairprice Healthcare Holdings", "methodology": "fee schedule", "standard_charge_dollar": 4.18, "additional_payer_notes": "Laboratory - 120.00% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ HMO POS", "methodology": "fee schedule", "standard_charge_dollar": 9.18, "additional_payer_notes": "177.30% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ Indemnity", "methodology": "fee schedule", "standard_charge_dollar": 9.18, "additional_payer_notes": "177.30% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ PPO", "methodology": "fee schedule", "standard_charge_dollar": 9.18, "additional_payer_notes": "177.30% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3.48, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Military Tricare", "methodology": "fee schedule", "standard_charge_dollar": 2.78, "additional_payer_notes": "80.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3.48, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 3.48, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC All Payer (02-01-2023 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 2.09 } ] } ] }, { "description": "Cysto/Uretero W/Lithotripsy", "code_information": [ { "code": "52356", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 24117.9, "discounted_cash": 6338.0, "minimum": 1715.0, "maximum": 19294.32, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 13438.13, "additional_payer_notes": "212.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medical Rental Network", "methodology": "fee schedule", "standard_charge_dollar": 13438.13, "additional_payer_notes": "212.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 6338.74, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "ALLY-ALIGN (FKA SPARTAN PLAN NJ, INC.)", "plan_name": "ALLY-ALIGN (FKA SPARTAN PLAN NJ, INC.)", "methodology": "fee schedule", "standard_charge_dollar": 6655.68, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Americhoice (UHC)", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 6338.74, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Amerihealth", "plan_name": "Amerihealth Medicare", "methodology": "fee schedule", "standard_charge_dollar": 6338.74, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 9314.78, "additional_payer_notes": "146.95% of Medicare Rates" }, { "payer_name": "Clover Health", "plan_name": "Clover Medicare", "methodology": "fee schedule", "standard_charge_dollar": 6338.74, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Coventry", "plan_name": "Coventry Auto", "methodology": "fee schedule", "standard_charge_dollar": 12677.48, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Coventry", "plan_name": "Coventry Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 12677.48, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "fee schedule", "standard_charge_dollar": 8874.24, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Fairprice Healthcare Holdings", "plan_name": "Fairprice Healthcare Holdings", "methodology": "fee schedule", "standard_charge_dollar": 10141.98, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ HMO POS", "methodology": "fee schedule", "standard_charge_dollar": 11238.59, "additional_payer_notes": "177.30% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ Indemnity", "methodology": "fee schedule", "standard_charge_dollar": 11238.59, "additional_payer_notes": "177.30% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ PPO", "methodology": "fee schedule", "standard_charge_dollar": 11238.59, "additional_payer_notes": "177.30% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon Medicare", "methodology": "fee schedule", "standard_charge_dollar": 6338.74, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Military Tricare", "methodology": "fee schedule", "standard_charge_dollar": 5070.99, "additional_payer_notes": "80.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 6338.74, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 6338.74, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC All Payer (02-01-2023 to 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 5667.0 }, { "payer_name": "UHC", "plan_name": "UHC Oxford (02-01-2023 to 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 5169.0 }, { "payer_name": "UHC - Adhoc", "plan_name": "UHC - Adhoc All Payer", "methodology": "case rate", "standard_charge_dollar": 6016.0 }, { "payer_name": "UHC - Adhoc", "plan_name": "UHC - Adhoc Oxford", "methodology": "case rate", "standard_charge_dollar": 5327.0 }, { "payer_name": "Wellcare", "plan_name": "Wellcare Insurance Exchange", "methodology": "fee schedule", "standard_charge_dollar": 8557.3, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 6338.74, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellchoice", "plan_name": "WELLCHOICE HMO of NJ (Empire) Commercial (HMO / HMO POS, PPO)", "methodology": "case rate", "standard_charge_dollar": 1715.0 }, { "payer_name": "Wellchoice", "plan_name": "WELLCHOICE HMO of NJ (Empire) Commercial (Indemnity)", "methodology": "case rate", "standard_charge_dollar": 1978.0 }, { "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup Medicare", "methodology": "fee schedule", "standard_charge_dollar": 6338.74, "additional_payer_notes": "100.00% of Medicare Rates" } ] } ] }, { "description": "CARDIAC ARREST, UNEXPLAINED WITHOUT CCMCC", "code_information": [ { "code": "298", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 6816.0, "minimum": 3012.89, "maximum": 12337.0867, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "case rate", "standard_charge_dollar": 12337.09, "additional_payer_notes": "181.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medical Rental Network", "methodology": "case rate", "standard_charge_dollar": 12337.09, "additional_payer_notes": "181.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "case rate", "standard_charge_dollar": 5779.83, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "ALLY-ALIGN (FKA SPARTAN PLAN NJ, INC.)", "plan_name": "ALLY-ALIGN (FKA SPARTAN PLAN NJ, INC.)", "methodology": "case rate", "standard_charge_dollar": 7156.87, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Americhoice (UHC)", "plan_name": "UHC Medicare", "methodology": "case rate", "standard_charge_dollar": 5779.83, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Amerihealth", "plan_name": "Amerihealth Medicare", "methodology": "case rate", "standard_charge_dollar": 5779.83, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Commercial", "methodology": "case rate", "standard_charge_dollar": 6658.11 }, { "payer_name": "Clover Health", "plan_name": "Clover Medicare", "methodology": "case rate", "standard_charge_dollar": 5779.83, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Coventry", "plan_name": "Coventry Auto", "methodology": "case rate", "standard_charge_dollar": 11587.32, "additional_payer_notes": "170.00% of Medicare Rates" }, { "payer_name": "Coventry", "plan_name": "Coventry Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 11587.32, "additional_payer_notes": "170.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "case rate", "standard_charge_dollar": 8860.89, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Fairprice Healthcare Holdings", "plan_name": "Fairprice Healthcare Holdings", "methodology": "case rate", "standard_charge_dollar": 10905.71, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon Medicare", "methodology": "case rate", "standard_charge_dollar": 5779.83, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon NJ Health Medicaid", "methodology": "case rate", "standard_charge_dollar": 3012.89 }, { "payer_name": "Humana", "plan_name": "Humana Military Tricare", "methodology": "case rate", "standard_charge_dollar": 5452.86, "additional_payer_notes": "80.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 6816.07, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 6426.42 }, { "payer_name": "UBH", "plan_name": "UBH Medicare", "methodology": "case rate", "standard_charge_dollar": 5779.83, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC All Payer (02-01-2023 to 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 7671.17 }, { "payer_name": "UHC", "plan_name": "UHC Oxford (02-01-2023 to 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 6685.42 }, { "payer_name": "UHC - Adhoc", "plan_name": "UHC - Adhoc All Payer", "methodology": "case rate", "standard_charge_dollar": 8143.1 }, { "payer_name": "UHC - Adhoc", "plan_name": "UHC - Adhoc Oxford", "methodology": "case rate", "standard_charge_dollar": 6889.3 }, { "payer_name": "Wellcare", "plan_name": "Wellcare Insurance Exchange", "methodology": "case rate", "standard_charge_dollar": 9201.69, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "case rate", "standard_charge_dollar": 5779.83, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup Medicare", "methodology": "case rate", "standard_charge_dollar": 5779.83, "additional_payer_notes": "100.00% of Medicare Rates" } ] } ] }, { "description": "MAJOR RESPIRATORY INFECTIONS & INFLAMMATIONS - SOI : 3", "code_information": [ { "code": "1373", "type": "APR-DRG" } ], "standard_charges": [ { "setting": "inpatient", "minimum": 11669.55, "maximum": 12836.51, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Better Health - Medi Medi", "methodology": "case rate", "standard_charge_dollar": 12836.51, "additional_payer_notes": "110% of State Medicaid Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Better Health Medicaid", "methodology": "case rate", "standard_charge_dollar": 12836.51, "additional_payer_notes": "110% of State Medicaid Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "case rate", "standard_charge_dollar": 11669.55, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "UBH", "plan_name": "UBH Medicaid", "methodology": "case rate", "standard_charge_dollar": 11669.55, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicaid (02/01/2023 to 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 11902.95, "additional_payer_notes": "102% of State Medicaid Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicaid", "methodology": "case rate", "standard_charge_dollar": 11669.55, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup Medicaid", "methodology": "case rate", "standard_charge_dollar": 11669.55, "additional_payer_notes": "100% of State Medicaid Rates" } ] } ] }, { "description": "Hc Comp Comm Supp Svs Prof Lvl, 15 Min", "code_information": [ { "code": "H2015", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 71.7, "minimum": 9.42, "maximum": 71.7, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 9.42, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon NJ Health Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 71.7 }, { "payer_name": "UBH", "plan_name": "UBH Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 71.7 }, { "payer_name": "UHC", "plan_name": "UHC Medicaid (02/01/2023 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 71.7 }, { "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup Medicaid", "methodology": "percent of total billed charges", "standard_charge_percentage": 19.09, "median_amount": 286.8, "10th_percentile": 286.8, "90th_percentile": 286.8, "count": "1 through 10" } ] } ] }, { "description": "Hc Blood Gases: Ph, Po2 & Pco2", "code_information": [ { "code": "82803", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 62.0, "discounted_cash": 26.0, "minimum": 11.8358, "maximum": 55.2684, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 55.27, "additional_payer_notes": "212.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medical Rental Network", "methodology": "fee schedule", "standard_charge_dollar": 55.27, "additional_payer_notes": "212.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 26.07, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "ALLY-ALIGN (FKA SPARTAN PLAN NJ, INC.)", "plan_name": "ALLY-ALIGN (FKA SPARTAN PLAN NJ, INC.)", "methodology": "fee schedule", "standard_charge_dollar": 27.37, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Americhoice (UHC)", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 26.07, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Amerihealth", "plan_name": "Amerihealth Medicare", "methodology": "fee schedule", "standard_charge_dollar": 26.07, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 37.8, "additional_payer_notes": "Laboratory - 145.00% of Medicare Rates" }, { "payer_name": "Clover Health", "plan_name": "Clover Medicare", "methodology": "fee schedule", "standard_charge_dollar": 26.07, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Coventry", "plan_name": "Coventry Auto", "methodology": "fee schedule", "standard_charge_dollar": 52.14, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Coventry", "plan_name": "Coventry Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 52.14, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "fee schedule", "standard_charge_dollar": 36.5, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Fairprice Healthcare Holdings", "plan_name": "Fairprice Healthcare Holdings", "methodology": "fee schedule", "standard_charge_dollar": 31.28, "additional_payer_notes": "Laboratory - 120.00% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ HMO POS", "methodology": "fee schedule", "standard_charge_dollar": 43.77, "additional_payer_notes": "177.30% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ Indemnity", "methodology": "fee schedule", "standard_charge_dollar": 43.77, "additional_payer_notes": "177.30% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ PPO", "methodology": "fee schedule", "standard_charge_dollar": 43.77, "additional_payer_notes": "177.30% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon Medicare", "methodology": "fee schedule", "standard_charge_dollar": 26.07, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Military Tricare", "methodology": "fee schedule", "standard_charge_dollar": 20.86, "additional_payer_notes": "80.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 26.07, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 26.07, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC All Payer (02-01-2023 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 15.64 }, { "payer_name": "UHC", "plan_name": "UHC Medicaid (02/01/2023 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 20.86 }, { "payer_name": "UHC", "plan_name": "UHC Oxford (02-01-2023 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 15.64 }, { "payer_name": "UHC - Adhoc", "plan_name": "UHC - Adhoc All Payer", "methodology": "fee schedule", "standard_charge_dollar": 26.07 }, { "payer_name": "UHC - Adhoc", "plan_name": "UHC - Adhoc Oxford", "methodology": "fee schedule", "standard_charge_dollar": 26.07 }, { "payer_name": "Wellcare", "plan_name": "Wellcare Insurance Exchange", "methodology": "fee schedule", "standard_charge_dollar": 35.19, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 26.07, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup Medicare", "methodology": "fee schedule", "standard_charge_dollar": 26.07, "additional_payer_notes": "100.00% of Medicare Rates" } ] } ] }, { "description": "Hc Mra Chest Wo Contrast - C8910 - 61800005", "code_information": [ { "code": "C8910", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 1845.25, "discounted_cash": 282.0, "minimum": 225.656, "maximum": 1568.4625, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 597.99, "additional_payer_notes": "212.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medical Rental Network", "methodology": "fee schedule", "standard_charge_dollar": 597.99, "additional_payer_notes": "212.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 282.07, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "ALLY-ALIGN (FKA SPARTAN PLAN NJ, INC.)", "plan_name": "ALLY-ALIGN (FKA SPARTAN PLAN NJ, INC.)", "methodology": "fee schedule", "standard_charge_dollar": 296.17, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Americhoice (UHC)", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 282.07, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Amerihealth", "plan_name": "Amerihealth HMO", "methodology": "fee schedule", "standard_charge_dollar": 886.6 }, { "payer_name": "Amerihealth", "plan_name": "Amerihealth Medicare", "methodology": "fee schedule", "standard_charge_dollar": 282.07, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 414.5, "additional_payer_notes": "146.95% of Medicare Rates" }, { "payer_name": "Clover Health", "plan_name": "Clover Medicare", "methodology": "fee schedule", "standard_charge_dollar": 282.07, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Coventry", "plan_name": "Coventry Auto", "methodology": "fee schedule", "standard_charge_dollar": 564.14, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Coventry", "plan_name": "Coventry Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 564.14, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "fee schedule", "standard_charge_dollar": 394.9, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Fairprice Healthcare Holdings", "plan_name": "Fairprice Healthcare Holdings", "methodology": "fee schedule", "standard_charge_dollar": 451.31, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ HMO POS", "methodology": "fee schedule", "standard_charge_dollar": 500.11, "additional_payer_notes": "177.30% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ Indemnity", "methodology": "fee schedule", "standard_charge_dollar": 500.11, "additional_payer_notes": "177.30% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ PPO", "methodology": "fee schedule", "standard_charge_dollar": 500.11, "additional_payer_notes": "177.30% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon Medicare", "methodology": "fee schedule", "standard_charge_dollar": 282.07, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Military Tricare", "methodology": "fee schedule", "standard_charge_dollar": 225.66, "additional_payer_notes": "80.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 282.07, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 282.07, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC All Payer (02-01-2023 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 345.2 }, { "payer_name": "UHC", "plan_name": "UHC Oxford (02-01-2023 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 345.2 }, { "payer_name": "UHC - Adhoc", "plan_name": "UHC - Adhoc All Payer", "methodology": "fee schedule", "standard_charge_dollar": 230.13 }, { "payer_name": "UHC - Adhoc", "plan_name": "UHC - Adhoc Oxford", "methodology": "fee schedule", "standard_charge_dollar": 230.13 }, { "payer_name": "Wellcare", "plan_name": "Wellcare Insurance Exchange", "methodology": "fee schedule", "standard_charge_dollar": 380.79, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 282.07, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup Medicare", "methodology": "fee schedule", "standard_charge_dollar": 282.07, "additional_payer_notes": "100.00% of Medicare Rates" } ] } ] }, { "description": "Exc Face Tum Deep 2 Cm/>", "code_information": [ { "code": "21014", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 17955.0, "discounted_cash": 3433.0, "minimum": 1715.0, "maximum": 14364.0, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 7280.0, "additional_payer_notes": "212.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medical Rental Network", "methodology": "fee schedule", "standard_charge_dollar": 7280.0, "additional_payer_notes": "212.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3433.96, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "ALLY-ALIGN (FKA SPARTAN PLAN NJ, INC.)", "plan_name": "ALLY-ALIGN (FKA SPARTAN PLAN NJ, INC.)", "methodology": "fee schedule", "standard_charge_dollar": 3605.66, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Americhoice (UHC)", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3433.96, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Amerihealth", "plan_name": "Amerihealth Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3433.96, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 5046.2, "additional_payer_notes": "146.95% of Medicare Rates" }, { "payer_name": "Clover Health", "plan_name": "Clover Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3433.96, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Coventry", "plan_name": "Coventry Auto", "methodology": "fee schedule", "standard_charge_dollar": 6867.92, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Coventry", "plan_name": "Coventry Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 6867.92, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "fee schedule", "standard_charge_dollar": 4807.54, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Fairprice Healthcare Holdings", "plan_name": "Fairprice Healthcare Holdings", "methodology": "fee schedule", "standard_charge_dollar": 5494.34, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ HMO POS", "methodology": "fee schedule", "standard_charge_dollar": 6088.41, "additional_payer_notes": "177.30% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ Indemnity", "methodology": "fee schedule", "standard_charge_dollar": 6088.41, "additional_payer_notes": "177.30% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ PPO", "methodology": "fee schedule", "standard_charge_dollar": 6088.41, "additional_payer_notes": "177.30% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3433.96, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Military Tricare", "methodology": "fee schedule", "standard_charge_dollar": 2747.17, "additional_payer_notes": "80.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3433.96, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 3433.96, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC All Payer (02-01-2023 to 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 3147.0 }, { "payer_name": "UHC", "plan_name": "UHC Oxford (02-01-2023 to 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 2297.0 }, { "payer_name": "UHC - Adhoc", "plan_name": "UHC - Adhoc All Payer", "methodology": "case rate", "standard_charge_dollar": 3341.0 }, { "payer_name": "UHC - Adhoc", "plan_name": "UHC - Adhoc Oxford", "methodology": "case rate", "standard_charge_dollar": 2367.0 }, { "payer_name": "Wellcare", "plan_name": "Wellcare Insurance Exchange", "methodology": "fee schedule", "standard_charge_dollar": 4635.85, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3433.96, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellchoice", "plan_name": "WELLCHOICE HMO of NJ (Empire) Commercial (HMO / HMO POS, PPO)", "methodology": "case rate", "standard_charge_dollar": 1715.0 }, { "payer_name": "Wellchoice", "plan_name": "WELLCHOICE HMO of NJ (Empire) Commercial (Indemnity)", "methodology": "case rate", "standard_charge_dollar": 1978.0 }, { "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3433.96, "additional_payer_notes": "100.00% of Medicare Rates" } ] } ] }, { "description": "Hc Gen Seq Analys Sol Org/Hemtolmphoid Neo 51/> Gen", "code_information": [ { "code": "81455", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 2919.6, "discounted_cash": 2919.0, "minimum": 557.3516, "maximum": 2919.6, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 2919.6, "additional_payer_notes": "212.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medical Rental Network", "methodology": "fee schedule", "standard_charge_dollar": 2919.6, "additional_payer_notes": "212.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2919.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "ALLY-ALIGN (FKA SPARTAN PLAN NJ, INC.)", "plan_name": "ALLY-ALIGN (FKA SPARTAN PLAN NJ, INC.)", "methodology": "fee schedule", "standard_charge_dollar": 2919.6, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Americhoice (UHC)", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2919.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Amerihealth", "plan_name": "Amerihealth Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2919.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 2919.6, "additional_payer_notes": "A Indicator - 155.00% of Medicare Rates" }, { "payer_name": "Clover Health", "plan_name": "Clover Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2919.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Coventry", "plan_name": "Coventry Auto", "methodology": "fee schedule", "standard_charge_dollar": 2919.6, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Coventry", "plan_name": "Coventry Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 2919.6, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "fee schedule", "standard_charge_dollar": 2919.6, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Fairprice Healthcare Holdings", "plan_name": "Fairprice Healthcare Holdings", "methodology": "fee schedule", "standard_charge_dollar": 2919.6, "additional_payer_notes": "Laboratory - 120.00% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ HMO POS", "methodology": "fee schedule", "standard_charge_dollar": 2061.24, "additional_payer_notes": "177.30% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ Indemnity", "methodology": "fee schedule", "standard_charge_dollar": 2061.24, "additional_payer_notes": "177.30% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ PPO", "methodology": "fee schedule", "standard_charge_dollar": 2061.24, "additional_payer_notes": "177.30% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2919.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Military Tricare", "methodology": "fee schedule", "standard_charge_dollar": 2335.68, "additional_payer_notes": "80.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2919.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 2919.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC All Payer (02-01-2023 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 1751.76 }, { "payer_name": "UHC", "plan_name": "UHC Medicaid (02/01/2023 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 2335.68 }, { "payer_name": "UHC", "plan_name": "UHC Oxford (02-01-2023 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 1751.76 }, { "payer_name": "UHC - Adhoc", "plan_name": "UHC - Adhoc All Payer", "methodology": "fee schedule", "standard_charge_dollar": 2919.6 }, { "payer_name": "UHC - Adhoc", "plan_name": "UHC - Adhoc Oxford", "methodology": "fee schedule", "standard_charge_dollar": 2919.6 }, { "payer_name": "Wellcare", "plan_name": "Wellcare Insurance Exchange", "methodology": "fee schedule", "standard_charge_dollar": 2919.6, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2919.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2919.6, "additional_payer_notes": "100.00% of Medicare Rates" } ] } ] }, { "description": "MAJOR CRANIALFACIAL BONE PROCEDURES - SOI : 2", "code_information": [ { "code": "0892", "type": "APR-DRG" } ], "standard_charges": [ { "setting": "inpatient", "minimum": 25289.5, "maximum": 27818.45, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Better Health - Medi Medi", "methodology": "case rate", "standard_charge_dollar": 27818.45, "additional_payer_notes": "110% of State Medicaid Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Better Health Medicaid", "methodology": "case rate", "standard_charge_dollar": 27818.45, "additional_payer_notes": "110% of State Medicaid Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "case rate", "standard_charge_dollar": 25289.5, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "UBH", "plan_name": "UBH Medicaid", "methodology": "case rate", "standard_charge_dollar": 25289.5, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicaid (02/01/2023 to 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 25795.29, "additional_payer_notes": "102% of State Medicaid Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicaid", "methodology": "case rate", "standard_charge_dollar": 25289.5, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup Medicaid", "methodology": "case rate", "standard_charge_dollar": 25289.5, "additional_payer_notes": "100% of State Medicaid Rates" } ] } ] }, { "description": "Drainage Of Gland Abscess", "code_information": [ { "code": "56420", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 13674.0, "discounted_cash": 239.0, "minimum": 156.1619, "maximum": 10939.2, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 506.68, "additional_payer_notes": "212.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medical Rental Network", "methodology": "fee schedule", "standard_charge_dollar": 506.68, "additional_payer_notes": "212.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 239.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "ALLY-ALIGN (FKA SPARTAN PLAN NJ, INC.)", "plan_name": "ALLY-ALIGN (FKA SPARTAN PLAN NJ, INC.)", "methodology": "fee schedule", "standard_charge_dollar": 250.95, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Americhoice (UHC)", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 239.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Amerihealth", "plan_name": "Amerihealth Medicare", "methodology": "fee schedule", "standard_charge_dollar": 239.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 351.21, "additional_payer_notes": "146.95% of Medicare Rates" }, { "payer_name": "Clover Health", "plan_name": "Clover Medicare", "methodology": "fee schedule", "standard_charge_dollar": 239.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Coventry", "plan_name": "Coventry Auto", "methodology": "fee schedule", "standard_charge_dollar": 478.0, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Coventry", "plan_name": "Coventry Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 478.0, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "fee schedule", "standard_charge_dollar": 334.6, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Fairprice Healthcare Holdings", "plan_name": "Fairprice Healthcare Holdings", "methodology": "fee schedule", "standard_charge_dollar": 382.4, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ HMO POS", "methodology": "fee schedule", "standard_charge_dollar": 423.75, "additional_payer_notes": "177.30% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ Indemnity", "methodology": "fee schedule", "standard_charge_dollar": 423.75, "additional_payer_notes": "177.30% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ PPO", "methodology": "fee schedule", "standard_charge_dollar": 423.75, "additional_payer_notes": "177.30% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon Medicare", "methodology": "fee schedule", "standard_charge_dollar": 239.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Military Tricare", "methodology": "fee schedule", "standard_charge_dollar": 191.2, "additional_payer_notes": "80.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 239.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 239.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC All Payer (02-01-2023 to 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 3057.0 }, { "payer_name": "UHC", "plan_name": "UHC Oxford (02-01-2023 to 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 2297.0 }, { "payer_name": "UHC - Adhoc", "plan_name": "UHC - Adhoc All Payer", "methodology": "case rate", "standard_charge_dollar": 3245.0 }, { "payer_name": "UHC - Adhoc", "plan_name": "UHC - Adhoc Oxford", "methodology": "case rate", "standard_charge_dollar": 2367.0 }, { "payer_name": "Wellcare", "plan_name": "Wellcare Insurance Exchange", "methodology": "fee schedule", "standard_charge_dollar": 322.65, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 239.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellchoice", "plan_name": "WELLCHOICE HMO of NJ (Empire) Commercial (HMO / HMO POS, PPO)", "methodology": "case rate", "standard_charge_dollar": 1715.0 }, { "payer_name": "Wellchoice", "plan_name": "WELLCHOICE HMO of NJ (Empire) Commercial (Indemnity)", "methodology": "case rate", "standard_charge_dollar": 1978.0 }, { "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup Medicare", "methodology": "fee schedule", "standard_charge_dollar": 239.0, "additional_payer_notes": "100.00% of Medicare Rates" } ] } ] }, { "description": "Hc Clsd Treat Ulna Shaft Fx Wo Amnip", "code_information": [ { "code": "25530", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 839.01, "discounted_cash": 291.0, "minimum": 160.167, "maximum": 839.01, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 618.19, "additional_payer_notes": "212.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medical Rental Network", "methodology": "fee schedule", "standard_charge_dollar": 618.19, "additional_payer_notes": "212.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 291.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "ALLY-ALIGN (FKA SPARTAN PLAN NJ, INC.)", "plan_name": "ALLY-ALIGN (FKA SPARTAN PLAN NJ, INC.)", "methodology": "fee schedule", "standard_charge_dollar": 306.18, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Americhoice (UHC)", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 291.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Amerihealth", "plan_name": "Amerihealth Medicare", "methodology": "fee schedule", "standard_charge_dollar": 291.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 428.51, "additional_payer_notes": "146.95% of Medicare Rates" }, { "payer_name": "Clover Health", "plan_name": "Clover Medicare", "methodology": "fee schedule", "standard_charge_dollar": 291.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Coventry", "plan_name": "Coventry Auto", "methodology": "fee schedule", "standard_charge_dollar": 583.2, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Coventry", "plan_name": "Coventry Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 583.2, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "fee schedule", "standard_charge_dollar": 408.24, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Fairprice Healthcare Holdings", "plan_name": "Fairprice Healthcare Holdings", "methodology": "fee schedule", "standard_charge_dollar": 466.56, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ HMO POS", "methodology": "fee schedule", "standard_charge_dollar": 517.01, "additional_payer_notes": "177.30% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ Indemnity", "methodology": "fee schedule", "standard_charge_dollar": 517.01, "additional_payer_notes": "177.30% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ PPO", "methodology": "fee schedule", "standard_charge_dollar": 517.01, "additional_payer_notes": "177.30% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon Medicare", "methodology": "fee schedule", "standard_charge_dollar": 291.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Military Tricare", "methodology": "fee schedule", "standard_charge_dollar": 233.28, "additional_payer_notes": "80.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 291.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 291.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC All Payer (02-01-2023 to 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 839.01 }, { "payer_name": "UHC", "plan_name": "UHC Oxford (02-01-2023 to 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 839.01 }, { "payer_name": "UHC - Adhoc", "plan_name": "UHC - Adhoc All Payer", "methodology": "case rate", "standard_charge_dollar": 839.01 }, { "payer_name": "UHC - Adhoc", "plan_name": "UHC - Adhoc Oxford", "methodology": "case rate", "standard_charge_dollar": 839.01 }, { "payer_name": "Wellcare", "plan_name": "Wellcare Insurance Exchange", "methodology": "fee schedule", "standard_charge_dollar": 393.66, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 291.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup Medicare", "methodology": "fee schedule", "standard_charge_dollar": 291.6, "additional_payer_notes": "100.00% of Medicare Rates" } ] } ] }, { "description": "SICKLE CELL ANEMIA CRISIS - SOI : 1", "code_information": [ { "code": "6621", "type": "APR-DRG" } ], "standard_charges": [ { "setting": "inpatient", "minimum": 6343.32, "maximum": 6977.65, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Better Health - Medi Medi", "methodology": "case rate", "standard_charge_dollar": 6977.65, "additional_payer_notes": "110% of State Medicaid Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Better Health Medicaid", "methodology": "case rate", "standard_charge_dollar": 6977.65, "additional_payer_notes": "110% of State Medicaid Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "case rate", "standard_charge_dollar": 6343.32, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "UBH", "plan_name": "UBH Medicaid", "methodology": "case rate", "standard_charge_dollar": 6343.32, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicaid (02/01/2023 to 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 6470.19, "additional_payer_notes": "102% of State Medicaid Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicaid", "methodology": "case rate", "standard_charge_dollar": 6343.32, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup Medicaid", "methodology": "case rate", "standard_charge_dollar": 6343.32, "additional_payer_notes": "100% of State Medicaid Rates" } ] } ] }, { "description": "Wrist arthroscopysurgery", "code_information": [ { "code": "29845", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 14425.0, "discounted_cash": 3868.0, "minimum": 1715.0, "maximum": 11540.0, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 8200.52, "additional_payer_notes": "212.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medical Rental Network", "methodology": "fee schedule", "standard_charge_dollar": 8200.52, "additional_payer_notes": "212.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3868.17, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "ALLY-ALIGN (FKA SPARTAN PLAN NJ, INC.)", "plan_name": "ALLY-ALIGN (FKA SPARTAN PLAN NJ, INC.)", "methodology": "fee schedule", "standard_charge_dollar": 4061.58, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Americhoice (UHC)", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3868.17, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Amerihealth", "plan_name": "Amerihealth Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3868.17, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 5684.28, "additional_payer_notes": "146.95% of Medicare Rates" }, { "payer_name": "Clover Health", "plan_name": "Clover Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3868.17, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Coventry", "plan_name": "Coventry Auto", "methodology": "fee schedule", "standard_charge_dollar": 7736.34, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Coventry", "plan_name": "Coventry Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 7736.34, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "fee schedule", "standard_charge_dollar": 5415.44, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Fairprice Healthcare Holdings", "plan_name": "Fairprice Healthcare Holdings", "methodology": "fee schedule", "standard_charge_dollar": 6189.07, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ HMO POS", "methodology": "fee schedule", "standard_charge_dollar": 6858.27, "additional_payer_notes": "177.30% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ Indemnity", "methodology": "fee schedule", "standard_charge_dollar": 6858.27, "additional_payer_notes": "177.30% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ PPO", "methodology": "fee schedule", "standard_charge_dollar": 6858.27, "additional_payer_notes": "177.30% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3868.17, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Military Tricare", "methodology": "fee schedule", "standard_charge_dollar": 3094.54, "additional_payer_notes": "80.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3868.17, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 3868.17, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC All Payer (02-01-2023 to 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 5378.0 }, { "payer_name": "UHC", "plan_name": "UHC Oxford (02-01-2023 to 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 5169.0 }, { "payer_name": "UHC - Adhoc", "plan_name": "UHC - Adhoc All Payer", "methodology": "case rate", "standard_charge_dollar": 5709.0 }, { "payer_name": "UHC - Adhoc", "plan_name": "UHC - Adhoc Oxford", "methodology": "case rate", "standard_charge_dollar": 5327.0 }, { "payer_name": "Wellcare", "plan_name": "Wellcare Insurance Exchange", "methodology": "fee schedule", "standard_charge_dollar": 5222.03, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3868.17, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellchoice", "plan_name": "WELLCHOICE HMO of NJ (Empire) Commercial (HMO / HMO POS, PPO)", "methodology": "case rate", "standard_charge_dollar": 1715.0 }, { "payer_name": "Wellchoice", "plan_name": "WELLCHOICE HMO of NJ (Empire) Commercial (Indemnity)", "methodology": "case rate", "standard_charge_dollar": 1978.0 }, { "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3868.17, "additional_payer_notes": "100.00% of Medicare Rates" } ] } ] }, { "description": "Hc Ct Scan Of Abdomen Combo", "code_information": [ { "code": "74170", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 3368.66, "discounted_cash": 207.0, "minimum": 165.888, "maximum": 2863.361, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 439.6, "additional_payer_notes": "212.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medical Rental Network", "methodology": "fee schedule", "standard_charge_dollar": 439.6, "additional_payer_notes": "212.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 207.36, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "ALLY-ALIGN (FKA SPARTAN PLAN NJ, INC.)", "plan_name": "ALLY-ALIGN (FKA SPARTAN PLAN NJ, INC.)", "methodology": "fee schedule", "standard_charge_dollar": 217.73, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Americhoice (UHC)", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 207.36, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Amerihealth", "plan_name": "Amerihealth HMO", "methodology": "fee schedule", "standard_charge_dollar": 619.01 }, { "payer_name": "Amerihealth", "plan_name": "Amerihealth Medicare", "methodology": "fee schedule", "standard_charge_dollar": 207.36, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 304.72, "additional_payer_notes": "146.95% of Medicare Rates" }, { "payer_name": "Clover Health", "plan_name": "Clover Medicare", "methodology": "fee schedule", "standard_charge_dollar": 207.36, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Coventry", "plan_name": "Coventry Auto", "methodology": "fee schedule", "standard_charge_dollar": 414.72, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Coventry", "plan_name": "Coventry Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 414.72, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "fee schedule", "standard_charge_dollar": 290.3, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Fairprice Healthcare Holdings", "plan_name": "Fairprice Healthcare Holdings", "methodology": "fee schedule", "standard_charge_dollar": 331.78, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ HMO POS", "methodology": "fee schedule", "standard_charge_dollar": 367.65, "additional_payer_notes": "177.30% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ Indemnity", "methodology": "fee schedule", "standard_charge_dollar": 367.65, "additional_payer_notes": "177.30% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ PPO", "methodology": "fee schedule", "standard_charge_dollar": 367.65, "additional_payer_notes": "177.30% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon Medicare", "methodology": "fee schedule", "standard_charge_dollar": 207.36, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Military Tricare", "methodology": "fee schedule", "standard_charge_dollar": 165.89, "additional_payer_notes": "80.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 207.36, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 207.36, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC All Payer (02-01-2023 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 267.83 }, { "payer_name": "UHC", "plan_name": "UHC Oxford (02-01-2023 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 267.83 }, { "payer_name": "UHC - Adhoc", "plan_name": "UHC - Adhoc All Payer", "methodology": "fee schedule", "standard_charge_dollar": 178.55 }, { "payer_name": "UHC - Adhoc", "plan_name": "UHC - Adhoc Oxford", "methodology": "fee schedule", "standard_charge_dollar": 178.55 }, { "payer_name": "Wellcare", "plan_name": "Wellcare Insurance Exchange", "methodology": "fee schedule", "standard_charge_dollar": 279.94, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 207.36, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup Medicaid", "methodology": "percent of total billed charges", "standard_charge_percentage": 19.09, "median_amount": 628.26, "10th_percentile": 628.26, "90th_percentile": 628.26, "count": "1 through 10" }, { "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup Medicare", "methodology": "fee schedule", "standard_charge_dollar": 207.36, "additional_payer_notes": "100.00% of Medicare Rates" } ] } ] }, { "description": "Hc Abdom Paracentesis Dx/Ther W Imaging Guidance", "code_information": [ { "code": "49083", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 3721.36, "discounted_cash": 1072.0, "minimum": 710.4076, "maximum": 3721.36, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 2273.15, "additional_payer_notes": "212.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medical Rental Network", "methodology": "fee schedule", "standard_charge_dollar": 2273.15, "additional_payer_notes": "212.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1072.24, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "ALLY-ALIGN (FKA SPARTAN PLAN NJ, INC.)", "plan_name": "ALLY-ALIGN (FKA SPARTAN PLAN NJ, INC.)", "methodology": "fee schedule", "standard_charge_dollar": 1125.85, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Americhoice (UHC)", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1072.24, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Amerihealth", "plan_name": "Amerihealth Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1072.24, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 1575.66, "additional_payer_notes": "146.95% of Medicare Rates" }, { "payer_name": "Clover Health", "plan_name": "Clover Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1072.24, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Coventry", "plan_name": "Coventry Auto", "methodology": "fee schedule", "standard_charge_dollar": 2144.48, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Coventry", "plan_name": "Coventry Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 2144.48, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "fee schedule", "standard_charge_dollar": 1501.14, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Fairprice Healthcare Holdings", "plan_name": "Fairprice Healthcare Holdings", "methodology": "fee schedule", "standard_charge_dollar": 1715.58, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ HMO POS", "methodology": "fee schedule", "standard_charge_dollar": 1901.08, "additional_payer_notes": "177.30% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ Indemnity", "methodology": "fee schedule", "standard_charge_dollar": 1901.08, "additional_payer_notes": "177.30% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ PPO", "methodology": "fee schedule", "standard_charge_dollar": 1901.08, "additional_payer_notes": "177.30% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1072.24, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon NJ Health Medicaid", "methodology": "percent of total billed charges", "standard_charge_percentage": 19.58, "median_amount": 555.8, "10th_percentile": 555.8, "90th_percentile": 555.8, "count": "1 through 10" }, { "payer_name": "Humana", "plan_name": "Humana Military Tricare", "methodology": "fee schedule", "standard_charge_dollar": 857.79, "additional_payer_notes": "80.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1072.24, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 1072.24, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC All Payer (02-01-2023 to 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 3721.36 }, { "payer_name": "UHC", "plan_name": "UHC Oxford (02-01-2023 to 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 3676.0 }, { "payer_name": "UHC - Adhoc", "plan_name": "UHC - Adhoc All Payer", "methodology": "case rate", "standard_charge_dollar": 3721.36 }, { "payer_name": "UHC - Adhoc", "plan_name": "UHC - Adhoc Oxford", "methodology": "case rate", "standard_charge_dollar": 3721.36 }, { "payer_name": "Wellcare", "plan_name": "Wellcare Insurance Exchange", "methodology": "fee schedule", "standard_charge_dollar": 1447.52, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1072.24, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup Medicaid", "methodology": "percent of total billed charges", "standard_charge_percentage": 19.09, "median_amount": 529.4, "10th_percentile": 529.4, "90th_percentile": 529.4, "count": "1 through 10" }, { "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1072.24, "additional_payer_notes": "100.00% of Medicare Rates" } ] } ] }, { "description": "INSJ BIOMECHANICAL DEVICE - 22859 - ", "code_information": [ { "code": "22859", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 5432.13, "minimum": 1036.9936, "maximum": 4345.704, "payers_information": [ { "payer_name": "UHC", "plan_name": "UHC All Payer (02-01-2023 to 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 3057.0 }, { "payer_name": "UHC", "plan_name": "UHC Oxford (02-01-2023 to 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 2297.0 }, { "payer_name": "UHC - Adhoc", "plan_name": "UHC - Adhoc All Payer", "methodology": "case rate", "standard_charge_dollar": 3245.0 }, { "payer_name": "UHC - Adhoc", "plan_name": "UHC - Adhoc Oxford", "methodology": "case rate", "standard_charge_dollar": 2367.0 }, { "payer_name": "Wellchoice", "plan_name": "WELLCHOICE HMO of NJ (Empire) Commercial (HMO / HMO POS, PPO)", "methodology": "case rate", "standard_charge_dollar": 1715.0 }, { "payer_name": "Wellchoice", "plan_name": "WELLCHOICE HMO of NJ (Empire) Commercial (Indemnity)", "methodology": "case rate", "standard_charge_dollar": 1978.0 } ] } ] }, { "description": "URINARY STONES & ACQUIRED UPPER URINARY TRACT OBSTRUCTION - SOI : 4", "code_information": [ { "code": "4654", "type": "APR-DRG" } ], "standard_charges": [ { "setting": "inpatient", "minimum": 21484.28, "maximum": 23632.71, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Better Health - Medi Medi", "methodology": "case rate", "standard_charge_dollar": 23632.71, "additional_payer_notes": "110% of State Medicaid Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Better Health Medicaid", "methodology": "case rate", "standard_charge_dollar": 23632.71, "additional_payer_notes": "110% of State Medicaid Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "case rate", "standard_charge_dollar": 21484.28, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "UBH", "plan_name": "UBH Medicaid", "methodology": "case rate", "standard_charge_dollar": 21484.28, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicaid (02/01/2023 to 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 21913.96, "additional_payer_notes": "102% of State Medicaid Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicaid", "methodology": "case rate", "standard_charge_dollar": 21484.28, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup Medicaid", "methodology": "case rate", "standard_charge_dollar": 21484.28, "additional_payer_notes": "100% of State Medicaid Rates" } ] } ] }, { "description": "Hc Perq Breast Loc Dev Place Strotact Guid Add Les", "code_information": [ { "code": "19284", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 200.0, "minimum": 38.18, "maximum": 200.0, "payers_information": [ { "payer_name": "UHC", "plan_name": "UHC All Payer (02-01-2023 to 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 200.0 }, { "payer_name": "UHC", "plan_name": "UHC Oxford (02-01-2023 to 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 200.0 }, { "payer_name": "UHC - Adhoc", "plan_name": "UHC - Adhoc All Payer", "methodology": "case rate", "standard_charge_dollar": 200.0 }, { "payer_name": "UHC - Adhoc", "plan_name": "UHC - Adhoc Oxford", "methodology": "case rate", "standard_charge_dollar": 200.0 } ] } ] }, { "description": "Hc Whirlpool Therapy", "code_information": [ { "code": "97022", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 218.0, "discounted_cash": 17.0, "minimum": 14.104, "maximum": 218.0, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 37.38, "additional_payer_notes": "212.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medical Rental Network", "methodology": "fee schedule", "standard_charge_dollar": 37.38, "additional_payer_notes": "212.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 17.63, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "ALLY-ALIGN (FKA SPARTAN PLAN NJ, INC.)", "plan_name": "ALLY-ALIGN (FKA SPARTAN PLAN NJ, INC.)", "methodology": "fee schedule", "standard_charge_dollar": 18.51, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Americhoice (UHC)", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 17.63, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Amerihealth", "plan_name": "Amerihealth Medicare", "methodology": "fee schedule", "standard_charge_dollar": 17.63, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 158.0, "additional_payer_notes": "A Indicator - 155.00% of Medicare Rates" }, { "payer_name": "Clover Health", "plan_name": "Clover Medicare", "methodology": "fee schedule", "standard_charge_dollar": 17.63, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Coventry", "plan_name": "Coventry Auto", "methodology": "fee schedule", "standard_charge_dollar": 35.26, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Coventry", "plan_name": "Coventry Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 35.26, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "fee schedule", "standard_charge_dollar": 24.68, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Fairprice Healthcare Holdings", "plan_name": "Fairprice Healthcare Holdings", "methodology": "fee schedule", "standard_charge_dollar": 28.21 }, { "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ HMO POS", "methodology": "fee schedule", "standard_charge_dollar": 153.91, "additional_payer_notes": "177.30% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ Indemnity", "methodology": "fee schedule", "standard_charge_dollar": 153.91, "additional_payer_notes": "177.30% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ PPO", "methodology": "fee schedule", "standard_charge_dollar": 153.91, "additional_payer_notes": "177.30% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon Medicare", "methodology": "fee schedule", "standard_charge_dollar": 17.63, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Military Tricare", "methodology": "fee schedule", "standard_charge_dollar": 14.1, "additional_payer_notes": "80.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 17.63, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 17.63, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC All Payer (02-01-2023 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 218.0 }, { "payer_name": "UHC", "plan_name": "UHC Oxford (02-01-2023 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 218.0 }, { "payer_name": "UHC - Adhoc", "plan_name": "UHC - Adhoc All Payer", "methodology": "fee schedule", "standard_charge_dollar": 218.0 }, { "payer_name": "UHC - Adhoc", "plan_name": "UHC - Adhoc Oxford", "methodology": "fee schedule", "standard_charge_dollar": 218.0 }, { "payer_name": "Wellcare", "plan_name": "Wellcare Insurance Exchange", "methodology": "fee schedule", "standard_charge_dollar": 23.8, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 17.63, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup Medicare", "methodology": "fee schedule", "standard_charge_dollar": 17.63, "additional_payer_notes": "100.00% of Medicare Rates" } ] } ] }, { "description": "Hc Microalbumin, Quantitative", "code_information": [ { "code": "82043", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 135.96, "discounted_cash": 5.0, "minimum": 3.47, "maximum": 115.566, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 12.25, "additional_payer_notes": "212.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medical Rental Network", "methodology": "fee schedule", "standard_charge_dollar": 12.25, "additional_payer_notes": "212.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5.78, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "ALLY-ALIGN (FKA SPARTAN PLAN NJ, INC.)", "plan_name": "ALLY-ALIGN (FKA SPARTAN PLAN NJ, INC.)", "methodology": "fee schedule", "standard_charge_dollar": 6.07, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Americhoice (UHC)", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5.78, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Amerihealth", "plan_name": "Amerihealth Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5.78, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 8.38, "additional_payer_notes": "Laboratory - 145.00% of Medicare Rates" }, { "payer_name": "Clover Health", "plan_name": "Clover Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5.78, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Coventry", "plan_name": "Coventry Auto", "methodology": "fee schedule", "standard_charge_dollar": 11.56, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Coventry", "plan_name": "Coventry Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 11.56, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "fee schedule", "standard_charge_dollar": 8.09, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Fairprice Healthcare Holdings", "plan_name": "Fairprice Healthcare Holdings", "methodology": "fee schedule", "standard_charge_dollar": 6.94, "additional_payer_notes": "Laboratory - 120.00% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ HMO POS", "methodology": "fee schedule", "standard_charge_dollar": 95.99, "additional_payer_notes": "177.30% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ Indemnity", "methodology": "fee schedule", "standard_charge_dollar": 95.99, "additional_payer_notes": "177.30% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ PPO", "methodology": "fee schedule", "standard_charge_dollar": 95.99, "additional_payer_notes": "177.30% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5.78, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Military Tricare", "methodology": "fee schedule", "standard_charge_dollar": 4.62, "additional_payer_notes": "80.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5.78, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 5.78, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC All Payer (02-01-2023 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 3.47 }, { "payer_name": "UHC", "plan_name": "UHC Medicaid (02/01/2023 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 4.62 }, { "payer_name": "UHC", "plan_name": "UHC Oxford (02-01-2023 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 3.47 }, { "payer_name": "UHC - Adhoc", "plan_name": "UHC - Adhoc All Payer", "methodology": "fee schedule", "standard_charge_dollar": 5.78 }, { "payer_name": "UHC - Adhoc", "plan_name": "UHC - Adhoc Oxford", "methodology": "fee schedule", "standard_charge_dollar": 5.78 }, { "payer_name": "Wellcare", "plan_name": "Wellcare Insurance Exchange", "methodology": "fee schedule", "standard_charge_dollar": 7.8, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5.78, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5.78, "additional_payer_notes": "100.00% of Medicare Rates" } ] } ] }, { "description": "OTHER NERVOUS SYSTEM & RELATED PROCEDURES - SOI : 2", "code_information": [ { "code": "0262", "type": "APR-DRG" } ], "standard_charges": [ { "setting": "inpatient", "minimum": 19561.02, "maximum": 21517.12, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Better Health - Medi Medi", "methodology": "case rate", "standard_charge_dollar": 21517.12, "additional_payer_notes": "110% of State Medicaid Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Better Health Medicaid", "methodology": "case rate", "standard_charge_dollar": 21517.12, "additional_payer_notes": "110% of State Medicaid Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "case rate", "standard_charge_dollar": 19561.02, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "UBH", "plan_name": "UBH Medicaid", "methodology": "case rate", "standard_charge_dollar": 19561.02, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicaid (02/01/2023 to 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 19952.24, "additional_payer_notes": "102% of State Medicaid Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicaid", "methodology": "case rate", "standard_charge_dollar": 19561.02, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup Medicaid", "methodology": "case rate", "standard_charge_dollar": 19561.02, "additional_payer_notes": "100% of State Medicaid Rates" } ] } ] }, { "description": "SEIZURES WITH MCC", "code_information": [ { "code": "100", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 23939.0, "minimum": 11317.23, "maximum": 43330.1149, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "case rate", "standard_charge_dollar": 43330.11, "additional_payer_notes": "181.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medical Rental Network", "methodology": "case rate", "standard_charge_dollar": 43330.11, "additional_payer_notes": "181.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "case rate", "standard_charge_dollar": 19529.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "ALLY-ALIGN (FKA SPARTAN PLAN NJ, INC.)", "plan_name": "ALLY-ALIGN (FKA SPARTAN PLAN NJ, INC.)", "methodology": "case rate", "standard_charge_dollar": 25136.25, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Americhoice (UHC)", "plan_name": "UHC Medicare", "methodology": "case rate", "standard_charge_dollar": 19529.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Amerihealth", "plan_name": "Amerihealth Medicare", "methodology": "case rate", "standard_charge_dollar": 19529.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Commercial", "methodology": "case rate", "standard_charge_dollar": 28335.38 }, { "payer_name": "Clover Health", "plan_name": "Clover Medicare", "methodology": "case rate", "standard_charge_dollar": 19529.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Coventry", "plan_name": "Coventry Auto", "methodology": "case rate", "standard_charge_dollar": 40696.79, "additional_payer_notes": "170.00% of Medicare Rates" }, { "payer_name": "Coventry", "plan_name": "Coventry Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 40696.79, "additional_payer_notes": "170.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "case rate", "standard_charge_dollar": 31121.08, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Fairprice Healthcare Holdings", "plan_name": "Fairprice Healthcare Holdings", "methodology": "case rate", "standard_charge_dollar": 38302.86, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon Medicare", "methodology": "case rate", "standard_charge_dollar": 19529.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon NJ Health Medicaid", "methodology": "case rate", "standard_charge_dollar": 11317.23 }, { "payer_name": "Humana", "plan_name": "Humana Military Tricare", "methodology": "case rate", "standard_charge_dollar": 19151.43, "additional_payer_notes": "80.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 23939.29, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 20862.6 }, { "payer_name": "UBH", "plan_name": "UBH Medicare", "methodology": "case rate", "standard_charge_dollar": 19529.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC All Payer (02-01-2023 to 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 32646.7 }, { "payer_name": "UHC", "plan_name": "UHC Oxford (02-01-2023 to 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 28451.59 }, { "payer_name": "UHC - Adhoc", "plan_name": "UHC - Adhoc All Payer", "methodology": "case rate", "standard_charge_dollar": 34655.16 }, { "payer_name": "UHC - Adhoc", "plan_name": "UHC - Adhoc Oxford", "methodology": "case rate", "standard_charge_dollar": 29319.28 }, { "payer_name": "Wellcare", "plan_name": "Wellcare Insurance Exchange", "methodology": "case rate", "standard_charge_dollar": 32318.04, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "case rate", "standard_charge_dollar": 19529.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup Medicare", "methodology": "case rate", "standard_charge_dollar": 19529.3, "additional_payer_notes": "100.00% of Medicare Rates" } ] } ] }, { "description": "Hc Hep B Core Ab Test, Total", "code_information": [ { "code": "86704", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 80.0, "discounted_cash": 12.0, "minimum": 7.23, "maximum": 68.0, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 25.55, "additional_payer_notes": "212.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medical Rental Network", "methodology": "fee schedule", "standard_charge_dollar": 25.55, "additional_payer_notes": "212.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 12.05, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "ALLY-ALIGN (FKA SPARTAN PLAN NJ, INC.)", "plan_name": "ALLY-ALIGN (FKA SPARTAN PLAN NJ, INC.)", "methodology": "fee schedule", "standard_charge_dollar": 12.65, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Americhoice (UHC)", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 12.05, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Amerihealth", "plan_name": "Amerihealth Medicare", "methodology": "fee schedule", "standard_charge_dollar": 12.05, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 17.47, "additional_payer_notes": "Laboratory - 145.00% of Medicare Rates" }, { "payer_name": "Clover Health", "plan_name": "Clover Medicare", "methodology": "fee schedule", "standard_charge_dollar": 12.05, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Coventry", "plan_name": "Coventry Auto", "methodology": "fee schedule", "standard_charge_dollar": 24.1, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Coventry", "plan_name": "Coventry Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 24.1, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "fee schedule", "standard_charge_dollar": 16.87, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Fairprice Healthcare Holdings", "plan_name": "Fairprice Healthcare Holdings", "methodology": "fee schedule", "standard_charge_dollar": 14.46, "additional_payer_notes": "Laboratory - 120.00% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ HMO POS", "methodology": "fee schedule", "standard_charge_dollar": 56.48, "additional_payer_notes": "177.30% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ Indemnity", "methodology": "fee schedule", "standard_charge_dollar": 56.48, "additional_payer_notes": "177.30% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ PPO", "methodology": "fee schedule", "standard_charge_dollar": 56.48, "additional_payer_notes": "177.30% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon Medicare", "methodology": "fee schedule", "standard_charge_dollar": 12.05, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Military Tricare", "methodology": "fee schedule", "standard_charge_dollar": 9.64, "additional_payer_notes": "80.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 12.05, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 12.05, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC All Payer (02-01-2023 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 7.23 }, { "payer_name": "UHC", "plan_name": "UHC Medicaid (02/01/2023 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 9.64 }, { "payer_name": "UHC", "plan_name": "UHC Oxford (02-01-2023 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 7.23 }, { "payer_name": "UHC - Adhoc", "plan_name": "UHC - Adhoc All Payer", "methodology": "fee schedule", "standard_charge_dollar": 12.05 }, { "payer_name": "UHC - Adhoc", "plan_name": "UHC - Adhoc Oxford", "methodology": "fee schedule", "standard_charge_dollar": 12.05 }, { "payer_name": "Wellcare", "plan_name": "Wellcare Insurance Exchange", "methodology": "fee schedule", "standard_charge_dollar": 16.27, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 12.05, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup Medicare", "methodology": "fee schedule", "standard_charge_dollar": 12.05, "additional_payer_notes": "100.00% of Medicare Rates" } ] } ] }, { "description": "RADIOTHERAPY - SOI : 3", "code_information": [ { "code": "6923", "type": "APR-DRG" } ], "standard_charges": [ { "setting": "inpatient", "minimum": 24369.09, "maximum": 26806.0, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Better Health - Medi Medi", "methodology": "case rate", "standard_charge_dollar": 26806.0, "additional_payer_notes": "110% of State Medicaid Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Better Health Medicaid", "methodology": "case rate", "standard_charge_dollar": 26806.0, "additional_payer_notes": "110% of State Medicaid Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "case rate", "standard_charge_dollar": 24369.09, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "UBH", "plan_name": "UBH Medicaid", "methodology": "case rate", "standard_charge_dollar": 24369.09, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicaid (02/01/2023 to 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 24856.47, "additional_payer_notes": "102% of State Medicaid Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicaid", "methodology": "case rate", "standard_charge_dollar": 24369.09, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup Medicaid", "methodology": "case rate", "standard_charge_dollar": 24369.09, "additional_payer_notes": "100% of State Medicaid Rates" } ] } ] }, { "description": "Hc Eval,Oral & Pharyngeal Swallow Function, 60 Min", "code_information": [ { "code": "92610", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 435.0, "discounted_cash": 62.0, "minimum": 50.232, "maximum": 432.0, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 133.11, "additional_payer_notes": "212.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medical Rental Network", "methodology": "fee schedule", "standard_charge_dollar": 133.11, "additional_payer_notes": "212.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 62.79, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "ALLY-ALIGN (FKA SPARTAN PLAN NJ, INC.)", "plan_name": "ALLY-ALIGN (FKA SPARTAN PLAN NJ, INC.)", "methodology": "fee schedule", "standard_charge_dollar": 65.93, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Americhoice (UHC)", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 62.79, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Amerihealth", "plan_name": "Amerihealth Medicare", "methodology": "fee schedule", "standard_charge_dollar": 62.79, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 158.0, "additional_payer_notes": "A Indicator - 155.00% of Medicare Rates" }, { "payer_name": "Clover Health", "plan_name": "Clover Medicare", "methodology": "fee schedule", "standard_charge_dollar": 62.79, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Coventry", "plan_name": "Coventry Auto", "methodology": "fee schedule", "standard_charge_dollar": 125.58, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Coventry", "plan_name": "Coventry Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 125.58, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "fee schedule", "standard_charge_dollar": 87.91, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Fairprice Healthcare Holdings", "plan_name": "Fairprice Healthcare Holdings", "methodology": "fee schedule", "standard_charge_dollar": 100.46 }, { "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ HMO POS", "methodology": "fee schedule", "standard_charge_dollar": 307.11, "additional_payer_notes": "177.30% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ Indemnity", "methodology": "fee schedule", "standard_charge_dollar": 307.11, "additional_payer_notes": "177.30% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ PPO", "methodology": "fee schedule", "standard_charge_dollar": 307.11, "additional_payer_notes": "177.30% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon Medicare", "methodology": "fee schedule", "standard_charge_dollar": 62.79, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon NJ Health Medicaid", "methodology": "percent of total billed charges", "standard_charge_percentage": 19.58, "median_amount": 93.09, "10th_percentile": 93.09, "90th_percentile": 94.17, "count": "1 through 10" }, { "payer_name": "Humana", "plan_name": "Humana Military Tricare", "methodology": "fee schedule", "standard_charge_dollar": 50.23, "additional_payer_notes": "80.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 62.79, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 62.79, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC All Payer (02-01-2023 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 407.0 }, { "payer_name": "UHC", "plan_name": "UHC Medicaid (02/01/2023 to 12-31-2026)", "methodology": "percent of total billed charges", "standard_charge_percentage": 19.47, "median_amount": 94.17, "10th_percentile": 93.09, "90th_percentile": 94.17, "count": "1 through 10" }, { "payer_name": "UHC", "plan_name": "UHC Oxford (02-01-2023 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 357.0 }, { "payer_name": "UHC - Adhoc", "plan_name": "UHC - Adhoc All Payer", "methodology": "fee schedule", "standard_charge_dollar": 432.0 }, { "payer_name": "UHC - Adhoc", "plan_name": "UHC - Adhoc Oxford", "methodology": "fee schedule", "standard_charge_dollar": 368.0 }, { "payer_name": "Wellcare", "plan_name": "Wellcare Insurance Exchange", "methodology": "fee schedule", "standard_charge_dollar": 84.77, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 62.79, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup Medicaid", "methodology": "percent of total billed charges", "standard_charge_percentage": 19.09, "median_amount": 81.13, "10th_percentile": 81.13, "90th_percentile": 93.09, "count": "1 through 10" }, { "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup Medicare", "methodology": "fee schedule", "standard_charge_dollar": 62.79, "additional_payer_notes": "100.00% of Medicare Rates" } ] } ] }, { "description": "Dbrdmt skin abdominal wall", "code_information": [ { "code": "11005", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 15390.0, "minimum": 583.28, "maximum": 12312.0, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 583.28, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC All Payer (02-01-2023 to 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 4889.0 }, { "payer_name": "UHC", "plan_name": "UHC Oxford (02-01-2023 to 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 4020.0 }, { "payer_name": "UHC - Adhoc", "plan_name": "UHC - Adhoc All Payer", "methodology": "case rate", "standard_charge_dollar": 5190.0 }, { "payer_name": "UHC - Adhoc", "plan_name": "UHC - Adhoc Oxford", "methodology": "case rate", "standard_charge_dollar": 4143.0 }, { "payer_name": "Wellchoice", "plan_name": "WELLCHOICE HMO of NJ (Empire) Commercial (HMO / HMO POS, PPO)", "methodology": "case rate", "standard_charge_dollar": 1715.0 }, { "payer_name": "Wellchoice", "plan_name": "WELLCHOICE HMO of NJ (Empire) Commercial (Indemnity)", "methodology": "case rate", "standard_charge_dollar": 1978.0 } ] } ] }, { "description": "Hc Clsd Treat Mandible Fx Wo Manip", "code_information": [ { "code": "21450", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 1815.74, "discounted_cash": 637.0, "minimum": 346.6248, "maximum": 1815.74, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 1351.69, "additional_payer_notes": "212.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medical Rental Network", "methodology": "fee schedule", "standard_charge_dollar": 1351.69, "additional_payer_notes": "212.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 637.59, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "ALLY-ALIGN (FKA SPARTAN PLAN NJ, INC.)", "plan_name": "ALLY-ALIGN (FKA SPARTAN PLAN NJ, INC.)", "methodology": "fee schedule", "standard_charge_dollar": 669.47, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Americhoice (UHC)", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 637.59, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Amerihealth", "plan_name": "Amerihealth Medicare", "methodology": "fee schedule", "standard_charge_dollar": 637.59, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 936.94, "additional_payer_notes": "146.95% of Medicare Rates" }, { "payer_name": "Clover Health", "plan_name": "Clover Medicare", "methodology": "fee schedule", "standard_charge_dollar": 637.59, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Coventry", "plan_name": "Coventry Auto", "methodology": "fee schedule", "standard_charge_dollar": 1275.18, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Coventry", "plan_name": "Coventry Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 1275.18, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "fee schedule", "standard_charge_dollar": 892.63, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Fairprice Healthcare Holdings", "plan_name": "Fairprice Healthcare Holdings", "methodology": "fee schedule", "standard_charge_dollar": 1020.14, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ HMO POS", "methodology": "fee schedule", "standard_charge_dollar": 1130.45, "additional_payer_notes": "177.30% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ Indemnity", "methodology": "fee schedule", "standard_charge_dollar": 1130.45, "additional_payer_notes": "177.30% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ PPO", "methodology": "fee schedule", "standard_charge_dollar": 1130.45, "additional_payer_notes": "177.30% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon Medicare", "methodology": "fee schedule", "standard_charge_dollar": 637.59, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Military Tricare", "methodology": "fee schedule", "standard_charge_dollar": 510.07, "additional_payer_notes": "80.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 637.59, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 637.59, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC All Payer (02-01-2023 to 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 1815.74 }, { "payer_name": "UHC", "plan_name": "UHC Oxford (02-01-2023 to 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 1815.74 }, { "payer_name": "UHC - Adhoc", "plan_name": "UHC - Adhoc All Payer", "methodology": "case rate", "standard_charge_dollar": 1815.74 }, { "payer_name": "UHC - Adhoc", "plan_name": "UHC - Adhoc Oxford", "methodology": "case rate", "standard_charge_dollar": 1815.74 }, { "payer_name": "Wellcare", "plan_name": "Wellcare Insurance Exchange", "methodology": "fee schedule", "standard_charge_dollar": 860.75, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 637.59, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup Medicare", "methodology": "fee schedule", "standard_charge_dollar": 637.59, "additional_payer_notes": "100.00% of Medicare Rates" } ] } ] }, { "description": "Hc Assay Phosphatase Acid Prostatic", "code_information": [ { "code": "84066", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 62.0, "discounted_cash": 9.0, "minimum": 5.8, "maximum": 52.7, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 20.48, "additional_payer_notes": "212.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medical Rental Network", "methodology": "fee schedule", "standard_charge_dollar": 20.48, "additional_payer_notes": "212.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 9.66, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "ALLY-ALIGN (FKA SPARTAN PLAN NJ, INC.)", "plan_name": "ALLY-ALIGN (FKA SPARTAN PLAN NJ, INC.)", "methodology": "fee schedule", "standard_charge_dollar": 10.14, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Americhoice (UHC)", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 9.66, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Amerihealth", "plan_name": "Amerihealth Medicare", "methodology": "fee schedule", "standard_charge_dollar": 9.66, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 14.01, "additional_payer_notes": "Laboratory - 145.00% of Medicare Rates" }, { "payer_name": "Clover Health", "plan_name": "Clover Medicare", "methodology": "fee schedule", "standard_charge_dollar": 9.66, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Coventry", "plan_name": "Coventry Auto", "methodology": "fee schedule", "standard_charge_dollar": 19.32, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Coventry", "plan_name": "Coventry Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 19.32, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "fee schedule", "standard_charge_dollar": 13.52, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Fairprice Healthcare Holdings", "plan_name": "Fairprice Healthcare Holdings", "methodology": "fee schedule", "standard_charge_dollar": 11.59, "additional_payer_notes": "Laboratory - 120.00% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ HMO POS", "methodology": "fee schedule", "standard_charge_dollar": 43.77, "additional_payer_notes": "177.30% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ Indemnity", "methodology": "fee schedule", "standard_charge_dollar": 43.77, "additional_payer_notes": "177.30% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ PPO", "methodology": "fee schedule", "standard_charge_dollar": 43.77, "additional_payer_notes": "177.30% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon Medicare", "methodology": "fee schedule", "standard_charge_dollar": 9.66, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Military Tricare", "methodology": "fee schedule", "standard_charge_dollar": 7.73, "additional_payer_notes": "80.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 9.66, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 9.66, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC All Payer (02-01-2023 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 5.8 }, { "payer_name": "UHC", "plan_name": "UHC Medicaid (02/01/2023 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 7.73 }, { "payer_name": "UHC", "plan_name": "UHC Oxford (02-01-2023 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 5.8 }, { "payer_name": "UHC - Adhoc", "plan_name": "UHC - Adhoc All Payer", "methodology": "fee schedule", "standard_charge_dollar": 9.66 }, { "payer_name": "UHC - Adhoc", "plan_name": "UHC - Adhoc Oxford", "methodology": "fee schedule", "standard_charge_dollar": 9.66 }, { "payer_name": "Wellcare", "plan_name": "Wellcare Insurance Exchange", "methodology": "fee schedule", "standard_charge_dollar": 13.04, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 9.66, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup Medicare", "methodology": "fee schedule", "standard_charge_dollar": 9.66, "additional_payer_notes": "100.00% of Medicare Rates" } ] } ] }, { "description": "DEGENERATIVE NERVOUS SYSTEM DISORDERS EXC MULT SCLEROSIS - SOI : 4", "code_information": [ { "code": "0424", "type": "APR-DRG" } ], "standard_charges": [ { "setting": "inpatient", "minimum": 26037.11, "maximum": 28640.82, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Better Health - Medi Medi", "methodology": "case rate", "standard_charge_dollar": 28640.82, "additional_payer_notes": "110% of State Medicaid Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Better Health Medicaid", "methodology": "case rate", "standard_charge_dollar": 28640.82, "additional_payer_notes": "110% of State Medicaid Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "case rate", "standard_charge_dollar": 26037.11, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "UBH", "plan_name": "UBH Medicaid", "methodology": "case rate", "standard_charge_dollar": 26037.11, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicaid (02/01/2023 to 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 26557.85, "additional_payer_notes": "102% of State Medicaid Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicaid", "methodology": "case rate", "standard_charge_dollar": 26037.11, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup Medicaid", "methodology": "case rate", "standard_charge_dollar": 26037.11, "additional_payer_notes": "100% of State Medicaid Rates" } ] } ] }, { "description": "MULTIPLE SCLEROSIS AND CEREBELLAR ATAXIA WITH CC", "code_information": [ { "code": "059", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 15897.0, "minimum": 6864.4, "maximum": 28773.8234, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "case rate", "standard_charge_dollar": 28773.82, "additional_payer_notes": "181.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medical Rental Network", "methodology": "case rate", "standard_charge_dollar": 28773.82, "additional_payer_notes": "181.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "case rate", "standard_charge_dollar": 13071.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "ALLY-ALIGN (FKA SPARTAN PLAN NJ, INC.)", "plan_name": "ALLY-ALIGN (FKA SPARTAN PLAN NJ, INC.)", "methodology": "case rate", "standard_charge_dollar": 16692.0, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Americhoice (UHC)", "plan_name": "UHC Medicare", "methodology": "case rate", "standard_charge_dollar": 13071.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Amerihealth", "plan_name": "Amerihealth Medicare", "methodology": "case rate", "standard_charge_dollar": 13071.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Commercial", "methodology": "case rate", "standard_charge_dollar": 18154.37 }, { "payer_name": "Clover Health", "plan_name": "Clover Medicare", "methodology": "case rate", "standard_charge_dollar": 13071.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Coventry", "plan_name": "Coventry Auto", "methodology": "case rate", "standard_charge_dollar": 27025.14, "additional_payer_notes": "170.00% of Medicare Rates" }, { "payer_name": "Coventry", "plan_name": "Coventry Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 27025.14, "additional_payer_notes": "170.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "case rate", "standard_charge_dollar": 20666.28, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Fairprice Healthcare Holdings", "plan_name": "Fairprice Healthcare Holdings", "methodology": "case rate", "standard_charge_dollar": 25435.42, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon Medicare", "methodology": "case rate", "standard_charge_dollar": 13071.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon NJ Health Medicaid", "methodology": "case rate", "standard_charge_dollar": 6864.4 }, { "payer_name": "Humana", "plan_name": "Humana Military Tricare", "methodology": "case rate", "standard_charge_dollar": 12717.71, "additional_payer_notes": "80.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 15897.14, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 17410.2 }, { "payer_name": "UBH", "plan_name": "UBH Medicare", "methodology": "case rate", "standard_charge_dollar": 13071.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC All Payer (02-01-2023 to 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 20916.61 }, { "payer_name": "UHC", "plan_name": "UHC Oxford (02-01-2023 to 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 18228.82 }, { "payer_name": "UHC - Adhoc", "plan_name": "UHC - Adhoc All Payer", "methodology": "case rate", "standard_charge_dollar": 22203.42 }, { "payer_name": "UHC - Adhoc", "plan_name": "UHC - Adhoc Oxford", "methodology": "case rate", "standard_charge_dollar": 18784.74 }, { "payer_name": "Wellcare", "plan_name": "Wellcare Insurance Exchange", "methodology": "case rate", "standard_charge_dollar": 21461.14, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "case rate", "standard_charge_dollar": 13071.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup Medicare", "methodology": "case rate", "standard_charge_dollar": 13071.7, "additional_payer_notes": "100.00% of Medicare Rates" } ] } ] }, { "description": "Hc Assay Of Prolactin", "code_information": [ { "code": "84146", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 196.0, "discounted_cash": 19.0, "minimum": 11.63, "maximum": 166.6, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 41.09, "additional_payer_notes": "212.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medical Rental Network", "methodology": "fee schedule", "standard_charge_dollar": 41.09, "additional_payer_notes": "212.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 19.38, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "ALLY-ALIGN (FKA SPARTAN PLAN NJ, INC.)", "plan_name": "ALLY-ALIGN (FKA SPARTAN PLAN NJ, INC.)", "methodology": "fee schedule", "standard_charge_dollar": 20.35, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Americhoice (UHC)", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 19.38, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Amerihealth", "plan_name": "Amerihealth Medicare", "methodology": "fee schedule", "standard_charge_dollar": 19.38, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 28.1, "additional_payer_notes": "Laboratory - 145.00% of Medicare Rates" }, { "payer_name": "Clover Health", "plan_name": "Clover Medicare", "methodology": "fee schedule", "standard_charge_dollar": 19.38, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Coventry", "plan_name": "Coventry Auto", "methodology": "fee schedule", "standard_charge_dollar": 38.76, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Coventry", "plan_name": "Coventry Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 38.76, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "fee schedule", "standard_charge_dollar": 27.13, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Fairprice Healthcare Holdings", "plan_name": "Fairprice Healthcare Holdings", "methodology": "fee schedule", "standard_charge_dollar": 23.26, "additional_payer_notes": "Laboratory - 120.00% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ HMO POS", "methodology": "fee schedule", "standard_charge_dollar": 138.38, "additional_payer_notes": "177.30% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ Indemnity", "methodology": "fee schedule", "standard_charge_dollar": 138.38, "additional_payer_notes": "177.30% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ PPO", "methodology": "fee schedule", "standard_charge_dollar": 138.38, "additional_payer_notes": "177.30% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon Medicare", "methodology": "fee schedule", "standard_charge_dollar": 19.38, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Military Tricare", "methodology": "fee schedule", "standard_charge_dollar": 15.5, "additional_payer_notes": "80.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 19.38, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 19.38, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC All Payer (02-01-2023 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 11.63 }, { "payer_name": "UHC", "plan_name": "UHC Medicaid (02/01/2023 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 15.5 }, { "payer_name": "UHC", "plan_name": "UHC Oxford (02-01-2023 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 11.63 }, { "payer_name": "UHC - Adhoc", "plan_name": "UHC - Adhoc All Payer", "methodology": "fee schedule", "standard_charge_dollar": 19.38 }, { "payer_name": "UHC - Adhoc", "plan_name": "UHC - Adhoc Oxford", "methodology": "fee schedule", "standard_charge_dollar": 19.38 }, { "payer_name": "Wellcare", "plan_name": "Wellcare Insurance Exchange", "methodology": "fee schedule", "standard_charge_dollar": 26.16, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 19.38, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup Medicare", "methodology": "fee schedule", "standard_charge_dollar": 19.38, "additional_payer_notes": "100.00% of Medicare Rates" } ] } ] }, { "description": "VAGINAL DELIVERY - SOI : 3", "code_information": [ { "code": "5603", "type": "APR-DRG" } ], "standard_charges": [ { "setting": "inpatient", "minimum": 6568.89, "maximum": 7225.78, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Better Health - Medi Medi", "methodology": "case rate", "standard_charge_dollar": 7225.78, "additional_payer_notes": "110% of State Medicaid Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Better Health Medicaid", "methodology": "case rate", "standard_charge_dollar": 7225.78, "additional_payer_notes": "110% of State Medicaid Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "case rate", "standard_charge_dollar": 6568.89, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "UBH", "plan_name": "UBH Medicaid", "methodology": "case rate", "standard_charge_dollar": 6568.89, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicaid (02/01/2023 to 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 6700.27, "additional_payer_notes": "102% of State Medicaid Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicaid", "methodology": "case rate", "standard_charge_dollar": 6568.89, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup Medicaid", "methodology": "case rate", "standard_charge_dollar": 6568.89, "additional_payer_notes": "100% of State Medicaid Rates" } ] } ] }, { "description": "OTHER MUSCULOSKELETAL SYSTEM AND CONNECTIVE TISSUE O.R. PROCEDURES WITHOUT CCMCC", "code_information": [ { "code": "517", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 19315.0, "minimum": 8622.8, "maximum": 34961.1455, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "case rate", "standard_charge_dollar": 34961.15, "additional_payer_notes": "181.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medical Rental Network", "methodology": "case rate", "standard_charge_dollar": 34961.15, "additional_payer_notes": "181.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "case rate", "standard_charge_dollar": 15816.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "ALLY-ALIGN (FKA SPARTAN PLAN NJ, INC.)", "plan_name": "ALLY-ALIGN (FKA SPARTAN PLAN NJ, INC.)", "methodology": "case rate", "standard_charge_dollar": 20281.33, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Americhoice (UHC)", "plan_name": "UHC Medicare", "methodology": "case rate", "standard_charge_dollar": 15816.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Amerihealth", "plan_name": "Amerihealth Medicare", "methodology": "case rate", "standard_charge_dollar": 15816.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Commercial", "methodology": "case rate", "standard_charge_dollar": 22481.92 }, { "payer_name": "Clover Health", "plan_name": "Clover Medicare", "methodology": "case rate", "standard_charge_dollar": 15816.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Coventry", "plan_name": "Coventry Auto", "methodology": "case rate", "standard_charge_dollar": 32836.44, "additional_payer_notes": "170.00% of Medicare Rates" }, { "payer_name": "Coventry", "plan_name": "Coventry Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 32836.44, "additional_payer_notes": "170.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "case rate", "standard_charge_dollar": 25110.22, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Fairprice Healthcare Holdings", "plan_name": "Fairprice Healthcare Holdings", "methodology": "case rate", "standard_charge_dollar": 30904.88, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon Medicare", "methodology": "case rate", "standard_charge_dollar": 15816.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon NJ Health Medicaid", "methodology": "case rate", "standard_charge_dollar": 8622.8 }, { "payer_name": "Humana", "plan_name": "Humana Military Tricare", "methodology": "case rate", "standard_charge_dollar": 15452.44, "additional_payer_notes": "80.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 19315.55, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 23273.0 }, { "payer_name": "UBH", "plan_name": "UBH Medicare", "methodology": "case rate", "standard_charge_dollar": 15816.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC All Payer (02-01-2023 to 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 25902.62 }, { "payer_name": "UHC", "plan_name": "UHC Oxford (02-01-2023 to 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 22574.12 }, { "payer_name": "UHC - Adhoc", "plan_name": "UHC - Adhoc All Payer", "methodology": "case rate", "standard_charge_dollar": 27496.17 }, { "payer_name": "UHC - Adhoc", "plan_name": "UHC - Adhoc Oxford", "methodology": "case rate", "standard_charge_dollar": 23262.56 }, { "payer_name": "Wellcare", "plan_name": "Wellcare Insurance Exchange", "methodology": "case rate", "standard_charge_dollar": 26075.99, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "case rate", "standard_charge_dollar": 15816.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup Medicare", "methodology": "case rate", "standard_charge_dollar": 15816.6, "additional_payer_notes": "100.00% of Medicare Rates" } ] } ] }, { "description": "Carpal Tunnel Surgery", "code_information": [ { "code": "64721", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 15390.0, "discounted_cash": 2308.0, "minimum": 1715.0, "maximum": 12312.0, "payers_information": [ { "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ PPO", "methodology": "fee schedule", "standard_charge_dollar": 4092.99, "additional_payer_notes": "177.30% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2308.51, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon NJ Health Medicaid", "methodology": "percent of total billed charges", "standard_charge_percentage": 19.58, "median_amount": 529.58, "10th_percentile": 376.67, "90th_percentile": 3013.36, "count": "1 through 10" }, { "payer_name": "Humana", "plan_name": "Humana Military Tricare", "methodology": "fee schedule", "standard_charge_dollar": 1846.81, "additional_payer_notes": "80.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2308.51, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 2308.51, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC All Payer (02-01-2023 to 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 4415.0 }, { "payer_name": "UHC", "plan_name": "UHC Oxford (02-01-2023 to 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 4020.0 }, { "payer_name": "UHC - Adhoc", "plan_name": "UHC - Adhoc All Payer", "methodology": "case rate", "standard_charge_dollar": 4687.0 }, { "payer_name": "UHC - Adhoc", "plan_name": "UHC - Adhoc Oxford", "methodology": "case rate", "standard_charge_dollar": 4143.0 }, { "payer_name": "Wellcare", "plan_name": "Wellcare Insurance Exchange", "methodology": "fee schedule", "standard_charge_dollar": 3116.49, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2308.51, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellchoice", "plan_name": "WELLCHOICE HMO of NJ (Empire) Commercial (HMO / HMO POS, PPO)", "methodology": "case rate", "standard_charge_dollar": 1715.0 }, { "payer_name": "Wellchoice", "plan_name": "WELLCHOICE HMO of NJ (Empire) Commercial (Indemnity)", "methodology": "case rate", "standard_charge_dollar": 1978.0 }, { "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2308.51, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 4894.04, "additional_payer_notes": "212.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medical Rental Network", "methodology": "fee schedule", "standard_charge_dollar": 4894.04, "additional_payer_notes": "212.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2308.51, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "ALLY-ALIGN (FKA SPARTAN PLAN NJ, INC.)", "plan_name": "ALLY-ALIGN (FKA SPARTAN PLAN NJ, INC.)", "methodology": "fee schedule", "standard_charge_dollar": 2423.94, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Americhoice (UHC)", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2308.51, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Amerihealth", "plan_name": "Amerihealth Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2308.51, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 3392.36, "additional_payer_notes": "146.95% of Medicare Rates" }, { "payer_name": "Clover Health", "plan_name": "Clover Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2308.51, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Coventry", "plan_name": "Coventry Auto", "methodology": "fee schedule", "standard_charge_dollar": 4617.02, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Coventry", "plan_name": "Coventry Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 4617.02, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "fee schedule", "standard_charge_dollar": 3231.91, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Fairprice Healthcare Holdings", "plan_name": "Fairprice Healthcare Holdings", "methodology": "fee schedule", "standard_charge_dollar": 3693.62, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ HMO POS", "methodology": "fee schedule", "standard_charge_dollar": 4092.99, "additional_payer_notes": "177.30% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ Indemnity", "methodology": "fee schedule", "standard_charge_dollar": 4092.99, "additional_payer_notes": "177.30% of Medicare Rates" } ] } ] }, { "description": "Hc Prq Drug Eluting Cor Stent Ather Br - C9603 - 48100195", "code_information": [ { "code": "C9603", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 13460.0, "minimum": 2297.0, "maximum": 18669.6, "payers_information": [ { "payer_name": "UHC", "plan_name": "UHC All Payer (02-01-2023 to 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 3057.0 }, { "payer_name": "UHC", "plan_name": "UHC Oxford (02-01-2023 to 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 2297.0 }, { "payer_name": "UHC - Adhoc", "plan_name": "UHC - Adhoc All Payer", "methodology": "case rate", "standard_charge_dollar": 3245.0 }, { "payer_name": "UHC - Adhoc", "plan_name": "UHC - Adhoc Oxford", "methodology": "case rate", "standard_charge_dollar": 2367.0 }, { "payer_name": "Wellchoice", "plan_name": "WELLCHOICE HMO of NJ (Empire) Commercial (HMO / HMO POS, PPO)", "methodology": "case rate", "standard_charge_dollar": 2472.0 }, { "payer_name": "Wellchoice", "plan_name": "WELLCHOICE HMO of NJ (Empire) Commercial (Indemnity)", "methodology": "case rate", "standard_charge_dollar": 2753.0 } ] } ] }, { "description": "COCAINE ABUSE & DEPENDENCE - SOI : 2", "code_information": [ { "code": "7742", "type": "APR-DRG" } ], "standard_charges": [ { "setting": "inpatient", "minimum": 4979.52, "maximum": 5477.48, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Better Health - Medi Medi", "methodology": "case rate", "standard_charge_dollar": 5477.48, "additional_payer_notes": "110% of State Medicaid Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Better Health Medicaid", "methodology": "case rate", "standard_charge_dollar": 5477.48, "additional_payer_notes": "110% of State Medicaid Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "case rate", "standard_charge_dollar": 4979.52, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "UBH", "plan_name": "UBH Medicaid", "methodology": "case rate", "standard_charge_dollar": 4979.52, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicaid (02/01/2023 to 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 5079.11, "additional_payer_notes": "102% of State Medicaid Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicaid", "methodology": "case rate", "standard_charge_dollar": 4979.52, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup Medicaid", "methodology": "case rate", "standard_charge_dollar": 4979.52, "additional_payer_notes": "100% of State Medicaid Rates" } ] } ] }, { "description": "Hc App Skn Sub Trnk/Arm/Leg Ttl 100Sqcm 1St 25 Sqcm", "code_information": [ { "code": "15271", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 7486.49, "discounted_cash": 873.0, "minimum": 698.984, "maximum": 5989.192, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 1852.31, "additional_payer_notes": "212.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medical Rental Network", "methodology": "fee schedule", "standard_charge_dollar": 1852.31, "additional_payer_notes": "212.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 873.73, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "ALLY-ALIGN (FKA SPARTAN PLAN NJ, INC.)", "plan_name": "ALLY-ALIGN (FKA SPARTAN PLAN NJ, INC.)", "methodology": "fee schedule", "standard_charge_dollar": 917.42, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Americhoice (UHC)", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 873.73, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Amerihealth", "plan_name": "Amerihealth Medicare", "methodology": "fee schedule", "standard_charge_dollar": 873.73, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 1283.95, "additional_payer_notes": "146.95% of Medicare Rates" }, { "payer_name": "Clover Health", "plan_name": "Clover Medicare", "methodology": "fee schedule", "standard_charge_dollar": 873.73, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Coventry", "plan_name": "Coventry Auto", "methodology": "fee schedule", "standard_charge_dollar": 1747.46, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Coventry", "plan_name": "Coventry Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 1747.46, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "fee schedule", "standard_charge_dollar": 1223.22, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Fairprice Healthcare Holdings", "plan_name": "Fairprice Healthcare Holdings", "methodology": "fee schedule", "standard_charge_dollar": 1397.97, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ HMO POS", "methodology": "fee schedule", "standard_charge_dollar": 1549.12, "additional_payer_notes": "177.30% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ Indemnity", "methodology": "fee schedule", "standard_charge_dollar": 1549.12, "additional_payer_notes": "177.30% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ PPO", "methodology": "fee schedule", "standard_charge_dollar": 1549.12, "additional_payer_notes": "177.30% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon Medicare", "methodology": "fee schedule", "standard_charge_dollar": 873.73, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Military Tricare", "methodology": "fee schedule", "standard_charge_dollar": 698.98, "additional_payer_notes": "80.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 873.73, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 873.73, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC All Payer (02-01-2023 to 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 3912.0 }, { "payer_name": "UHC", "plan_name": "UHC Oxford (02-01-2023 to 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 3676.0 }, { "payer_name": "UHC - Adhoc", "plan_name": "UHC - Adhoc All Payer", "methodology": "case rate", "standard_charge_dollar": 4153.0 }, { "payer_name": "UHC - Adhoc", "plan_name": "UHC - Adhoc Oxford", "methodology": "case rate", "standard_charge_dollar": 3788.0 }, { "payer_name": "Wellcare", "plan_name": "Wellcare Insurance Exchange", "methodology": "fee schedule", "standard_charge_dollar": 1179.54, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 873.73, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellchoice", "plan_name": "WELLCHOICE HMO of NJ (Empire) Commercial (HMO / HMO POS, PPO)", "methodology": "case rate", "standard_charge_dollar": 1715.0 }, { "payer_name": "Wellchoice", "plan_name": "WELLCHOICE HMO of NJ (Empire) Commercial (Indemnity)", "methodology": "case rate", "standard_charge_dollar": 1978.0 }, { "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup Medicare", "methodology": "fee schedule", "standard_charge_dollar": 873.73, "additional_payer_notes": "100.00% of Medicare Rates" } ] } ] }, { "description": "Ankle Arthroscopy/Surgery", "code_information": [ { "code": "29898", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 36153.0, "discounted_cash": 3868.0, "minimum": 1715.0, "maximum": 28922.4, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 8200.52, "additional_payer_notes": "212.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medical Rental Network", "methodology": "fee schedule", "standard_charge_dollar": 8200.52, "additional_payer_notes": "212.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3868.17, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "ALLY-ALIGN (FKA SPARTAN PLAN NJ, INC.)", "plan_name": "ALLY-ALIGN (FKA SPARTAN PLAN NJ, INC.)", "methodology": "fee schedule", "standard_charge_dollar": 4061.58, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Americhoice (UHC)", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3868.17, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Amerihealth", "plan_name": "Amerihealth Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3868.17, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 5684.28, "additional_payer_notes": "146.95% of Medicare Rates" }, { "payer_name": "Clover Health", "plan_name": "Clover Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3868.17, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Coventry", "plan_name": "Coventry Auto", "methodology": "fee schedule", "standard_charge_dollar": 7736.34, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Coventry", "plan_name": "Coventry Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 7736.34, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "fee schedule", "standard_charge_dollar": 5415.44, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Fairprice Healthcare Holdings", "plan_name": "Fairprice Healthcare Holdings", "methodology": "fee schedule", "standard_charge_dollar": 6189.07, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ HMO POS", "methodology": "fee schedule", "standard_charge_dollar": 6858.27, "additional_payer_notes": "177.30% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ Indemnity", "methodology": "fee schedule", "standard_charge_dollar": 6858.27, "additional_payer_notes": "177.30% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ PPO", "methodology": "fee schedule", "standard_charge_dollar": 6858.27, "additional_payer_notes": "177.30% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3868.17, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon NJ Health Medicaid", "methodology": "percent of total billed charges", "standard_charge_percentage": 19.58, "median_amount": 2097.41, "10th_percentile": 2097.41, "90th_percentile": 2097.41, "count": "1 through 10" }, { "payer_name": "Humana", "plan_name": "Humana Military Tricare", "methodology": "fee schedule", "standard_charge_dollar": 3094.54, "additional_payer_notes": "80.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3868.17, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 3868.17, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC All Payer (02-01-2023 to 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 5378.0 }, { "payer_name": "UHC", "plan_name": "UHC Oxford (02-01-2023 to 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 5169.0 }, { "payer_name": "UHC - Adhoc", "plan_name": "UHC - Adhoc All Payer", "methodology": "case rate", "standard_charge_dollar": 5709.0 }, { "payer_name": "UHC - Adhoc", "plan_name": "UHC - Adhoc Oxford", "methodology": "case rate", "standard_charge_dollar": 5327.0 }, { "payer_name": "Wellcare", "plan_name": "Wellcare Insurance Exchange", "methodology": "fee schedule", "standard_charge_dollar": 5222.03, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3868.17, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellchoice", "plan_name": "WELLCHOICE HMO of NJ (Empire) Commercial (HMO / HMO POS, PPO)", "methodology": "case rate", "standard_charge_dollar": 1715.0 }, { "payer_name": "Wellchoice", "plan_name": "WELLCHOICE HMO of NJ (Empire) Commercial (Indemnity)", "methodology": "case rate", "standard_charge_dollar": 1978.0 }, { "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup Medicaid", "methodology": "percent of total billed charges", "standard_charge_percentage": 19.09, "median_amount": 2690.26, "10th_percentile": 2690.26, "90th_percentile": 2690.26, "count": "1 through 10" }, { "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3868.17, "additional_payer_notes": "100.00% of Medicare Rates" } ] } ] }, { "description": "VAGINAL DELIVERY WITHOUT STERILIZATION OR D&C WITHOUT CCMCC", "code_information": [ { "code": "807", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 9348.0, "minimum": 4406.63, "maximum": 16920.0429, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "case rate", "standard_charge_dollar": 16920.04, "additional_payer_notes": "181.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medical Rental Network", "methodology": "case rate", "standard_charge_dollar": 16920.04, "additional_payer_notes": "181.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "case rate", "standard_charge_dollar": 7812.98, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "ALLY-ALIGN (FKA SPARTAN PLAN NJ, INC.)", "plan_name": "ALLY-ALIGN (FKA SPARTAN PLAN NJ, INC.)", "methodology": "case rate", "standard_charge_dollar": 9815.49, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Americhoice (UHC)", "plan_name": "UHC Medicare", "methodology": "case rate", "standard_charge_dollar": 7812.98, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Amerihealth", "plan_name": "Amerihealth Medicare", "methodology": "case rate", "standard_charge_dollar": 7812.98, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Commercial", "methodology": "case rate", "standard_charge_dollar": 9863.55 }, { "payer_name": "Clover Health", "plan_name": "Clover Medicare", "methodology": "case rate", "standard_charge_dollar": 7812.98, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Coventry", "plan_name": "Coventry Auto", "methodology": "case rate", "standard_charge_dollar": 15891.75, "additional_payer_notes": "170.00% of Medicare Rates" }, { "payer_name": "Coventry", "plan_name": "Coventry Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 15891.75, "additional_payer_notes": "170.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "case rate", "standard_charge_dollar": 12152.52, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Fairprice Healthcare Holdings", "plan_name": "Fairprice Healthcare Holdings", "methodology": "case rate", "standard_charge_dollar": 14956.94, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon Casualty Services Personal Injury Protection - PIP", "methodology": "case rate", "standard_charge_dollar": 6761.0 }, { "payer_name": "Horizon", "plan_name": "Horizon Casualty Services Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 6015.0 }, { "payer_name": "Horizon", "plan_name": "Horizon Medicare", "methodology": "case rate", "standard_charge_dollar": 7812.98, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon NJ Health Medicaid", "methodology": "case rate", "standard_charge_dollar": 4406.63 }, { "payer_name": "Humana", "plan_name": "Humana Military Tricare", "methodology": "case rate", "standard_charge_dollar": 7478.47, "additional_payer_notes": "80.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 9348.09, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 5504.98 }, { "payer_name": "UBH", "plan_name": "UBH Medicare", "methodology": "case rate", "standard_charge_dollar": 7812.98, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC All Payer (02-01-2023 to 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 7738.0 }, { "payer_name": "UHC", "plan_name": "UHC Oxford (02-01-2023 to 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 6742.0 }, { "payer_name": "UHC - Adhoc", "plan_name": "UHC - Adhoc All Payer", "methodology": "case rate", "standard_charge_dollar": 8214.0 }, { "payer_name": "UHC - Adhoc", "plan_name": "UHC - Adhoc Oxford", "methodology": "case rate", "standard_charge_dollar": 6948.0 }, { "payer_name": "Wellcare", "plan_name": "Wellcare Insurance Exchange", "methodology": "case rate", "standard_charge_dollar": 12619.92, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "case rate", "standard_charge_dollar": 7812.98, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellchoice", "plan_name": "WELLCHOICE HMO of NJ (Empire) Commercial (HMO / HMO POS, PPO)", "methodology": "case rate", "standard_charge_dollar": 5036.0 }, { "payer_name": "Wellchoice", "plan_name": "WELLCHOICE HMO of NJ (Empire) Commercial (Indemnity)", "methodology": "case rate", "standard_charge_dollar": 5709.0 }, { "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup Medicare", "methodology": "case rate", "standard_charge_dollar": 7812.98, "additional_payer_notes": "100.00% of Medicare Rates" } ] } ] }, { "description": "THYROID, PARATHYROID & THYROGLOSSAL PROCEDURES - SOI : 2", "code_information": [ { "code": "4042", "type": "APR-DRG" } ], "standard_charges": [ { "setting": "inpatient", "minimum": 17284.57, "maximum": 19013.03, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Better Health - Medi Medi", "methodology": "case rate", "standard_charge_dollar": 19013.03, "additional_payer_notes": "110% of State Medicaid Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Better Health Medicaid", "methodology": "case rate", "standard_charge_dollar": 19013.03, "additional_payer_notes": "110% of State Medicaid Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "case rate", "standard_charge_dollar": 17284.57, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "UBH", "plan_name": "UBH Medicaid", "methodology": "case rate", "standard_charge_dollar": 17284.57, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicaid (02/01/2023 to 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 17630.26, "additional_payer_notes": "102% of State Medicaid Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicaid", "methodology": "case rate", "standard_charge_dollar": 17284.57, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup Medicaid", "methodology": "case rate", "standard_charge_dollar": 17284.57, "additional_payer_notes": "100% of State Medicaid Rates" } ] } ] }, { "description": "Revision of eyelid", "code_information": [ { "code": "67880", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 10255.5, "discounted_cash": 2810.0, "minimum": 1715.0, "maximum": 8204.4, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 5958.62, "additional_payer_notes": "212.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medical Rental Network", "methodology": "fee schedule", "standard_charge_dollar": 5958.62, "additional_payer_notes": "212.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2810.67, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "ALLY-ALIGN (FKA SPARTAN PLAN NJ, INC.)", "plan_name": "ALLY-ALIGN (FKA SPARTAN PLAN NJ, INC.)", "methodology": "fee schedule", "standard_charge_dollar": 2951.2, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Americhoice (UHC)", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2810.67, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Amerihealth", "plan_name": "Amerihealth Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2810.67, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 4130.28, "additional_payer_notes": "146.95% of Medicare Rates" }, { "payer_name": "Clover Health", "plan_name": "Clover Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2810.67, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Coventry", "plan_name": "Coventry Auto", "methodology": "fee schedule", "standard_charge_dollar": 5621.34, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Coventry", "plan_name": "Coventry Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 5621.34, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "fee schedule", "standard_charge_dollar": 3934.94, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Fairprice Healthcare Holdings", "plan_name": "Fairprice Healthcare Holdings", "methodology": "fee schedule", "standard_charge_dollar": 4497.07, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ HMO POS", "methodology": "fee schedule", "standard_charge_dollar": 4983.32, "additional_payer_notes": "177.30% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ Indemnity", "methodology": "fee schedule", "standard_charge_dollar": 4983.32, "additional_payer_notes": "177.30% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ PPO", "methodology": "fee schedule", "standard_charge_dollar": 4983.32, "additional_payer_notes": "177.30% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2810.67, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Military Tricare", "methodology": "fee schedule", "standard_charge_dollar": 2248.54, "additional_payer_notes": "80.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2810.67, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 2810.67, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC All Payer (02-01-2023 to 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 4415.0 }, { "payer_name": "UHC", "plan_name": "UHC Oxford (02-01-2023 to 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 4020.0 }, { "payer_name": "UHC - Adhoc", "plan_name": "UHC - Adhoc All Payer", "methodology": "case rate", "standard_charge_dollar": 4687.0 }, { "payer_name": "UHC - Adhoc", "plan_name": "UHC - Adhoc Oxford", "methodology": "case rate", "standard_charge_dollar": 4143.0 }, { "payer_name": "Wellcare", "plan_name": "Wellcare Insurance Exchange", "methodology": "fee schedule", "standard_charge_dollar": 3794.4, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2810.67, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellchoice", "plan_name": "WELLCHOICE HMO of NJ (Empire) Commercial (HMO / HMO POS, PPO)", "methodology": "case rate", "standard_charge_dollar": 1715.0 }, { "payer_name": "Wellchoice", "plan_name": "WELLCHOICE HMO of NJ (Empire) Commercial (Indemnity)", "methodology": "case rate", "standard_charge_dollar": 1978.0 }, { "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2810.67, "additional_payer_notes": "100.00% of Medicare Rates" } ] } ] }, { "description": "Hc Clsd Treat Trimalleolar Fx Wo Manip", "code_information": [ { "code": "27816", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 839.01, "discounted_cash": 291.0, "minimum": 160.167, "maximum": 839.01, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 618.19, "additional_payer_notes": "212.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medical Rental Network", "methodology": "fee schedule", "standard_charge_dollar": 618.19, "additional_payer_notes": "212.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 291.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "ALLY-ALIGN (FKA SPARTAN PLAN NJ, INC.)", "plan_name": "ALLY-ALIGN (FKA SPARTAN PLAN NJ, INC.)", "methodology": "fee schedule", "standard_charge_dollar": 306.18, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Americhoice (UHC)", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 291.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Amerihealth", "plan_name": "Amerihealth Medicare", "methodology": "fee schedule", "standard_charge_dollar": 291.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 428.51, "additional_payer_notes": "146.95% of Medicare Rates" }, { "payer_name": "Clover Health", "plan_name": "Clover Medicare", "methodology": "fee schedule", "standard_charge_dollar": 291.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Coventry", "plan_name": "Coventry Auto", "methodology": "fee schedule", "standard_charge_dollar": 583.2, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Coventry", "plan_name": "Coventry Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 583.2, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "fee schedule", "standard_charge_dollar": 408.24, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Fairprice Healthcare Holdings", "plan_name": "Fairprice Healthcare Holdings", "methodology": "fee schedule", "standard_charge_dollar": 466.56, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ HMO POS", "methodology": "fee schedule", "standard_charge_dollar": 517.01, "additional_payer_notes": "177.30% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ Indemnity", "methodology": "fee schedule", "standard_charge_dollar": 517.01, "additional_payer_notes": "177.30% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ PPO", "methodology": "fee schedule", "standard_charge_dollar": 517.01, "additional_payer_notes": "177.30% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon Medicare", "methodology": "fee schedule", "standard_charge_dollar": 291.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Military Tricare", "methodology": "fee schedule", "standard_charge_dollar": 233.28, "additional_payer_notes": "80.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 291.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 291.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC All Payer (02-01-2023 to 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 839.01 }, { "payer_name": "UHC", "plan_name": "UHC Oxford (02-01-2023 to 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 839.01 }, { "payer_name": "UHC - Adhoc", "plan_name": "UHC - Adhoc All Payer", "methodology": "case rate", "standard_charge_dollar": 839.01 }, { "payer_name": "UHC - Adhoc", "plan_name": "UHC - Adhoc Oxford", "methodology": "case rate", "standard_charge_dollar": 839.01 }, { "payer_name": "Wellcare", "plan_name": "Wellcare Insurance Exchange", "methodology": "fee schedule", "standard_charge_dollar": 393.66, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 291.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup Medicare", "methodology": "fee schedule", "standard_charge_dollar": 291.6, "additional_payer_notes": "100.00% of Medicare Rates" } ] } ] }, { "description": "Hc Oral Function Therapy, 60 Min", "code_information": [ { "code": "92526", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 320.2, "discounted_cash": 93.0, "minimum": 61.1262, "maximum": 334.2, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 197.73, "additional_payer_notes": "212.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medical Rental Network", "methodology": "fee schedule", "standard_charge_dollar": 197.73, "additional_payer_notes": "212.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 93.27, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "ALLY-ALIGN (FKA SPARTAN PLAN NJ, INC.)", "plan_name": "ALLY-ALIGN (FKA SPARTAN PLAN NJ, INC.)", "methodology": "fee schedule", "standard_charge_dollar": 97.93, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Americhoice (UHC)", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 93.27, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Amerihealth", "plan_name": "Amerihealth Medicare", "methodology": "fee schedule", "standard_charge_dollar": 93.27, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 158.0, "additional_payer_notes": "A Indicator - 155.00% of Medicare Rates" }, { "payer_name": "Clover Health", "plan_name": "Clover Medicare", "methodology": "fee schedule", "standard_charge_dollar": 93.27, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Coventry", "plan_name": "Coventry Auto", "methodology": "fee schedule", "standard_charge_dollar": 186.54, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Coventry", "plan_name": "Coventry Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 186.54, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "fee schedule", "standard_charge_dollar": 130.58, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Fairprice Healthcare Holdings", "plan_name": "Fairprice Healthcare Holdings", "methodology": "fee schedule", "standard_charge_dollar": 149.23 }, { "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ HMO POS", "methodology": "fee schedule", "standard_charge_dollar": 226.06, "additional_payer_notes": "177.30% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ Indemnity", "methodology": "fee schedule", "standard_charge_dollar": 226.06, "additional_payer_notes": "177.30% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ PPO", "methodology": "fee schedule", "standard_charge_dollar": 226.06, "additional_payer_notes": "177.30% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon Medicare", "methodology": "fee schedule", "standard_charge_dollar": 93.27, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon NJ Health Medicaid", "methodology": "percent of total billed charges", "standard_charge_percentage": 19.58, "median_amount": 92.23, "10th_percentile": 92.23, "90th_percentile": 92.23, "count": "1 through 10" }, { "payer_name": "Humana", "plan_name": "Humana Military Tricare", "methodology": "fee schedule", "standard_charge_dollar": 74.62, "additional_payer_notes": "80.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 93.27, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 93.27, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC All Payer (02-01-2023 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 320.2 }, { "payer_name": "UHC", "plan_name": "UHC Medicaid (02/01/2023 to 12-31-2026)", "methodology": "percent of total billed charges", "standard_charge_percentage": 19.47, "median_amount": 93.27, "10th_percentile": 92.23, "90th_percentile": 93.27, "count": "1 through 10" }, { "payer_name": "UHC", "plan_name": "UHC Oxford (02-01-2023 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 320.2 }, { "payer_name": "UHC - Adhoc", "plan_name": "UHC - Adhoc All Payer", "methodology": "fee schedule", "standard_charge_dollar": 320.2 }, { "payer_name": "UHC - Adhoc", "plan_name": "UHC - Adhoc Oxford", "methodology": "fee schedule", "standard_charge_dollar": 320.2 }, { "payer_name": "Wellcare", "plan_name": "Wellcare Insurance Exchange", "methodology": "fee schedule", "standard_charge_dollar": 125.91, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 93.27, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup Medicaid", "methodology": "percent of total billed charges", "standard_charge_percentage": 19.09, "median_amount": 92.23, "10th_percentile": 92.23, "90th_percentile": 92.23, "count": "1 through 10" }, { "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup Medicare", "methodology": "fee schedule", "standard_charge_dollar": 93.27, "additional_payer_notes": "100.00% of Medicare Rates" } ] } ] }, { "description": "Hc Removal Impacted Cerumen Instrumentation Unilat", "code_information": [ { "code": "69210", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 251.09, "discounted_cash": 69.0, "minimum": 47.9331, "maximum": 251.09, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 147.85, "additional_payer_notes": "212.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medical Rental Network", "methodology": "fee schedule", "standard_charge_dollar": 147.85, "additional_payer_notes": "212.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 69.74, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "ALLY-ALIGN (FKA SPARTAN PLAN NJ, INC.)", "plan_name": "ALLY-ALIGN (FKA SPARTAN PLAN NJ, INC.)", "methodology": "fee schedule", "standard_charge_dollar": 73.23, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Americhoice (UHC)", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 69.74, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Amerihealth", "plan_name": "Amerihealth Medicare", "methodology": "fee schedule", "standard_charge_dollar": 69.74, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 102.48, "additional_payer_notes": "146.95% of Medicare Rates" }, { "payer_name": "Clover Health", "plan_name": "Clover Medicare", "methodology": "fee schedule", "standard_charge_dollar": 69.74, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Coventry", "plan_name": "Coventry Auto", "methodology": "fee schedule", "standard_charge_dollar": 139.48, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Coventry", "plan_name": "Coventry Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 139.48, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "fee schedule", "standard_charge_dollar": 97.64, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Fairprice Healthcare Holdings", "plan_name": "Fairprice Healthcare Holdings", "methodology": "fee schedule", "standard_charge_dollar": 111.58, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ HMO POS", "methodology": "fee schedule", "standard_charge_dollar": 123.65, "additional_payer_notes": "177.30% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ Indemnity", "methodology": "fee schedule", "standard_charge_dollar": 123.65, "additional_payer_notes": "177.30% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ PPO", "methodology": "fee schedule", "standard_charge_dollar": 123.65, "additional_payer_notes": "177.30% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon Medicare", "methodology": "fee schedule", "standard_charge_dollar": 69.74, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Military Tricare", "methodology": "fee schedule", "standard_charge_dollar": 55.79, "additional_payer_notes": "80.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 69.74, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 69.74, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC All Payer (02-01-2023 to 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 251.09 }, { "payer_name": "UHC", "plan_name": "UHC Oxford (02-01-2023 to 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 251.09 }, { "payer_name": "UHC - Adhoc", "plan_name": "UHC - Adhoc All Payer", "methodology": "case rate", "standard_charge_dollar": 251.09 }, { "payer_name": "UHC - Adhoc", "plan_name": "UHC - Adhoc Oxford", "methodology": "case rate", "standard_charge_dollar": 251.09 }, { "payer_name": "Wellcare", "plan_name": "Wellcare Insurance Exchange", "methodology": "fee schedule", "standard_charge_dollar": 94.15, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 69.74, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellchoice", "plan_name": "WELLCHOICE HMO of NJ (Empire) Commercial (HMO / HMO POS, PPO)", "methodology": "case rate", "standard_charge_dollar": 251.09 }, { "payer_name": "Wellchoice", "plan_name": "WELLCHOICE HMO of NJ (Empire) Commercial (Indemnity)", "methodology": "case rate", "standard_charge_dollar": 251.09 }, { "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup Medicare", "methodology": "fee schedule", "standard_charge_dollar": 69.74, "additional_payer_notes": "100.00% of Medicare Rates" } ] } ] }, { "description": "OTHER O.R. PROCEDURES OF THE BLOOD AND BLOOD FORMING ORGANS WITHOUT CCMCC", "code_information": [ { "code": "804", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 17227.0, "minimum": 7683.65, "maximum": 31181.3949, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "case rate", "standard_charge_dollar": 31181.39, "additional_payer_notes": "181.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medical Rental Network", "methodology": "case rate", "standard_charge_dollar": 31181.39, "additional_payer_notes": "181.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "case rate", "standard_charge_dollar": 14139.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "ALLY-ALIGN (FKA SPARTAN PLAN NJ, INC.)", "plan_name": "ALLY-ALIGN (FKA SPARTAN PLAN NJ, INC.)", "methodology": "case rate", "standard_charge_dollar": 18088.65, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Americhoice (UHC)", "plan_name": "UHC Medicare", "methodology": "case rate", "standard_charge_dollar": 14139.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Amerihealth", "plan_name": "Amerihealth Medicare", "methodology": "case rate", "standard_charge_dollar": 14139.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Commercial", "methodology": "case rate", "standard_charge_dollar": 19838.28 }, { "payer_name": "Clover Health", "plan_name": "Clover Medicare", "methodology": "case rate", "standard_charge_dollar": 14139.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Coventry", "plan_name": "Coventry Auto", "methodology": "case rate", "standard_charge_dollar": 29286.39, "additional_payer_notes": "170.00% of Medicare Rates" }, { "payer_name": "Coventry", "plan_name": "Coventry Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 29286.39, "additional_payer_notes": "170.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "case rate", "standard_charge_dollar": 22395.48, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Fairprice Healthcare Holdings", "plan_name": "Fairprice Healthcare Holdings", "methodology": "case rate", "standard_charge_dollar": 27563.66, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon Medicare", "methodology": "case rate", "standard_charge_dollar": 14139.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon NJ Health Medicaid", "methodology": "case rate", "standard_charge_dollar": 7683.65 }, { "payer_name": "Humana", "plan_name": "Humana Military Tricare", "methodology": "case rate", "standard_charge_dollar": 13781.83, "additional_payer_notes": "80.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 17227.29, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 15179.3 }, { "payer_name": "UBH", "plan_name": "UBH Medicare", "methodology": "case rate", "standard_charge_dollar": 14139.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC All Payer (02-01-2023 to 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 22856.74 }, { "payer_name": "UHC", "plan_name": "UHC Oxford (02-01-2023 to 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 19919.64 }, { "payer_name": "UHC - Adhoc", "plan_name": "UHC - Adhoc All Payer", "methodology": "case rate", "standard_charge_dollar": 24262.91 }, { "payer_name": "UHC - Adhoc", "plan_name": "UHC - Adhoc Oxford", "methodology": "case rate", "standard_charge_dollar": 20527.13 }, { "payer_name": "Wellcare", "plan_name": "Wellcare Insurance Exchange", "methodology": "case rate", "standard_charge_dollar": 23256.84, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "case rate", "standard_charge_dollar": 14139.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup Medicare", "methodology": "case rate", "standard_charge_dollar": 14139.8, "additional_payer_notes": "100.00% of Medicare Rates" } ] } ] }, { "description": "Hc Epi Autogrft Face/Nck/Hnd/Ft/Gen <100 Sqcm", "code_information": [ { "code": "15115", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 4233.0, "discounted_cash": 2439.0, "minimum": 808.0797, "maximum": 4233.0, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 4233.0, "additional_payer_notes": "212.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medical Rental Network", "methodology": "fee schedule", "standard_charge_dollar": 4233.0, "additional_payer_notes": "212.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2439.22, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "ALLY-ALIGN (FKA SPARTAN PLAN NJ, INC.)", "plan_name": "ALLY-ALIGN (FKA SPARTAN PLAN NJ, INC.)", "methodology": "fee schedule", "standard_charge_dollar": 2561.18, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Americhoice (UHC)", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2439.22, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Amerihealth", "plan_name": "Amerihealth Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2439.22, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 3584.43, "additional_payer_notes": "146.95% of Medicare Rates" }, { "payer_name": "Clover Health", "plan_name": "Clover Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2439.22, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Coventry", "plan_name": "Coventry Auto", "methodology": "fee schedule", "standard_charge_dollar": 4233.0, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Coventry", "plan_name": "Coventry Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 4233.0, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "fee schedule", "standard_charge_dollar": 3414.91, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Fairprice Healthcare Holdings", "plan_name": "Fairprice Healthcare Holdings", "methodology": "fee schedule", "standard_charge_dollar": 3902.75, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ HMO POS", "methodology": "fee schedule", "standard_charge_dollar": 4233.0, "additional_payer_notes": "177.30% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ Indemnity", "methodology": "fee schedule", "standard_charge_dollar": 4233.0, "additional_payer_notes": "177.30% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ PPO", "methodology": "fee schedule", "standard_charge_dollar": 4233.0, "additional_payer_notes": "177.30% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2439.22, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Military Tricare", "methodology": "fee schedule", "standard_charge_dollar": 1951.38, "additional_payer_notes": "80.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2439.22, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 2439.22, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC All Payer (02-01-2023 to 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 3912.0 }, { "payer_name": "UHC", "plan_name": "UHC Oxford (02-01-2023 to 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 3676.0 }, { "payer_name": "UHC - Adhoc", "plan_name": "UHC - Adhoc All Payer", "methodology": "case rate", "standard_charge_dollar": 4153.0 }, { "payer_name": "UHC - Adhoc", "plan_name": "UHC - Adhoc Oxford", "methodology": "case rate", "standard_charge_dollar": 3788.0 }, { "payer_name": "Wellcare", "plan_name": "Wellcare Insurance Exchange", "methodology": "fee schedule", "standard_charge_dollar": 3292.95, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2439.22, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellchoice", "plan_name": "WELLCHOICE HMO of NJ (Empire) Commercial (HMO / HMO POS, PPO)", "methodology": "case rate", "standard_charge_dollar": 1715.0 }, { "payer_name": "Wellchoice", "plan_name": "WELLCHOICE HMO of NJ (Empire) Commercial (Indemnity)", "methodology": "case rate", "standard_charge_dollar": 1978.0 }, { "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2439.22, "additional_payer_notes": "100.00% of Medicare Rates" } ] } ] }, { "description": "Hc Circumcision, Clamp, Newborn", "code_information": [ { "code": "54150", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 8964.95, "minimum": 1711.409, "maximum": 7620.2075, "payers_information": [ { "payer_name": "UHC", "plan_name": "UHC All Payer (02-01-2023 to 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 4415.0 }, { "payer_name": "UHC", "plan_name": "UHC Oxford (02-01-2023 to 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 4020.0 }, { "payer_name": "UHC - Adhoc", "plan_name": "UHC - Adhoc All Payer", "methodology": "case rate", "standard_charge_dollar": 4687.0 }, { "payer_name": "UHC - Adhoc", "plan_name": "UHC - Adhoc Oxford", "methodology": "case rate", "standard_charge_dollar": 4143.0 } ] } ] }, { "description": "Exc Neck Les Sc 3 Cm/>", "code_information": [ { "code": "21552", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 17313.8, "discounted_cash": 3433.0, "minimum": 1715.0, "maximum": 13851.04, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 7280.0, "additional_payer_notes": "212.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medical Rental Network", "methodology": "fee schedule", "standard_charge_dollar": 7280.0, "additional_payer_notes": "212.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3433.96, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "ALLY-ALIGN (FKA SPARTAN PLAN NJ, INC.)", "plan_name": "ALLY-ALIGN (FKA SPARTAN PLAN NJ, INC.)", "methodology": "fee schedule", "standard_charge_dollar": 3605.66, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Americhoice (UHC)", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3433.96, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Amerihealth", "plan_name": "Amerihealth Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3433.96, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 5046.2, "additional_payer_notes": "146.95% of Medicare Rates" }, { "payer_name": "Clover Health", "plan_name": "Clover Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3433.96, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Coventry", "plan_name": "Coventry Auto", "methodology": "fee schedule", "standard_charge_dollar": 6867.92, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Coventry", "plan_name": "Coventry Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 6867.92, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "fee schedule", "standard_charge_dollar": 4807.54, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Fairprice Healthcare Holdings", "plan_name": "Fairprice Healthcare Holdings", "methodology": "fee schedule", "standard_charge_dollar": 5494.34, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ HMO POS", "methodology": "fee schedule", "standard_charge_dollar": 6088.41, "additional_payer_notes": "177.30% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ Indemnity", "methodology": "fee schedule", "standard_charge_dollar": 6088.41, "additional_payer_notes": "177.30% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ PPO", "methodology": "fee schedule", "standard_charge_dollar": 6088.41, "additional_payer_notes": "177.30% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3433.96, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Military Tricare", "methodology": "fee schedule", "standard_charge_dollar": 2747.17, "additional_payer_notes": "80.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3433.96, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 3433.96, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC All Payer (02-01-2023 to 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 4415.0 }, { "payer_name": "UHC", "plan_name": "UHC Oxford (02-01-2023 to 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 4020.0 }, { "payer_name": "UHC - Adhoc", "plan_name": "UHC - Adhoc All Payer", "methodology": "case rate", "standard_charge_dollar": 4687.0 }, { "payer_name": "UHC - Adhoc", "plan_name": "UHC - Adhoc Oxford", "methodology": "case rate", "standard_charge_dollar": 4143.0 }, { "payer_name": "Wellcare", "plan_name": "Wellcare Insurance Exchange", "methodology": "fee schedule", "standard_charge_dollar": 4635.85, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3433.96, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellchoice", "plan_name": "WELLCHOICE HMO of NJ (Empire) Commercial (HMO / HMO POS, PPO)", "methodology": "case rate", "standard_charge_dollar": 1715.0 }, { "payer_name": "Wellchoice", "plan_name": "WELLCHOICE HMO of NJ (Empire) Commercial (Indemnity)", "methodology": "case rate", "standard_charge_dollar": 1978.0 }, { "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3433.96, "additional_payer_notes": "100.00% of Medicare Rates" } ] } ] }, { "description": "CLEFT LIP & PALATE REPAIR - SOI : 3", "code_information": [ { "code": "0953", "type": "APR-DRG" } ], "standard_charges": [ { "setting": "inpatient", "minimum": 16771.55, "maximum": 18448.71, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Better Health - Medi Medi", "methodology": "case rate", "standard_charge_dollar": 18448.71, "additional_payer_notes": "110% of State Medicaid Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Better Health Medicaid", "methodology": "case rate", "standard_charge_dollar": 18448.71, "additional_payer_notes": "110% of State Medicaid Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "case rate", "standard_charge_dollar": 16771.55, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "UBH", "plan_name": "UBH Medicaid", "methodology": "case rate", "standard_charge_dollar": 16771.55, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicaid (02/01/2023 to 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 17106.98, "additional_payer_notes": "102% of State Medicaid Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicaid", "methodology": "case rate", "standard_charge_dollar": 16771.55, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup Medicaid", "methodology": "case rate", "standard_charge_dollar": 16771.55, "additional_payer_notes": "100% of State Medicaid Rates" } ] } ] }, { "description": "Hc Doppler Cw/Pw Limited (93321)", "code_information": [ { "code": "93321", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 200.0, "minimum": 38.18, "maximum": 200.0, "payers_information": [ { "payer_name": "Horizon", "plan_name": "Horizon NJ Health Medicaid", "methodology": "percent of total billed charges", "standard_charge_percentage": 19.58, "median_amount": 39.16, "10th_percentile": 39.16, "90th_percentile": 39.16, "count": "1 through 10" }, { "payer_name": "UHC", "plan_name": "UHC All Payer (02-01-2023 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 200.0 }, { "payer_name": "UHC", "plan_name": "UHC Medicaid (02/01/2023 to 12-31-2026)", "methodology": "percent of total billed charges", "standard_charge_percentage": 19.47, "median_amount": 38.05, "10th_percentile": 38.05, "90th_percentile": 38.05, "count": "1 through 10" }, { "payer_name": "UHC", "plan_name": "UHC Oxford (02-01-2023 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 200.0 }, { "payer_name": "UHC - Adhoc", "plan_name": "UHC - Adhoc All Payer", "methodology": "fee schedule", "standard_charge_dollar": 200.0 }, { "payer_name": "UHC - Adhoc", "plan_name": "UHC - Adhoc Oxford", "methodology": "fee schedule", "standard_charge_dollar": 200.0 } ] } ] }, { "description": "Hc Inj Nerv Blck, Intercostal, Single", "code_information": [ { "code": "64420", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 2994.05, "discounted_cash": 834.0, "minimum": 571.5641, "maximum": 2994.05, "payers_information": [ { "payer_name": "ALLY-ALIGN (FKA SPARTAN PLAN NJ, INC.)", "plan_name": "ALLY-ALIGN (FKA SPARTAN PLAN NJ, INC.)", "methodology": "fee schedule", "standard_charge_dollar": 876.21, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Americhoice (UHC)", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 834.49, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Amerihealth", "plan_name": "Amerihealth Medicare", "methodology": "fee schedule", "standard_charge_dollar": 834.49, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 1226.28, "additional_payer_notes": "146.95% of Medicare Rates" }, { "payer_name": "Clover Health", "plan_name": "Clover Medicare", "methodology": "fee schedule", "standard_charge_dollar": 834.49, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Coventry", "plan_name": "Coventry Auto", "methodology": "fee schedule", "standard_charge_dollar": 1668.98, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Coventry", "plan_name": "Coventry Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 1668.98, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "fee schedule", "standard_charge_dollar": 1168.29, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Fairprice Healthcare Holdings", "plan_name": "Fairprice Healthcare Holdings", "methodology": "fee schedule", "standard_charge_dollar": 1335.18, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ HMO POS", "methodology": "fee schedule", "standard_charge_dollar": 1479.55, "additional_payer_notes": "177.30% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ Indemnity", "methodology": "fee schedule", "standard_charge_dollar": 1479.55, "additional_payer_notes": "177.30% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ PPO", "methodology": "fee schedule", "standard_charge_dollar": 1479.55, "additional_payer_notes": "177.30% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon Medicare", "methodology": "fee schedule", "standard_charge_dollar": 834.49, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Military Tricare", "methodology": "fee schedule", "standard_charge_dollar": 667.59, "additional_payer_notes": "80.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 834.49, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 834.49, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC All Payer (02-01-2023 to 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 2994.05 }, { "payer_name": "UHC", "plan_name": "UHC Oxford (02-01-2023 to 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 2297.0 }, { "payer_name": "UHC - Adhoc", "plan_name": "UHC - Adhoc All Payer", "methodology": "case rate", "standard_charge_dollar": 2994.05 }, { "payer_name": "UHC - Adhoc", "plan_name": "UHC - Adhoc Oxford", "methodology": "case rate", "standard_charge_dollar": 2367.0 }, { "payer_name": "Wellcare", "plan_name": "Wellcare Insurance Exchange", "methodology": "fee schedule", "standard_charge_dollar": 1126.56, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 834.49, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup Medicare", "methodology": "fee schedule", "standard_charge_dollar": 834.49, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 1769.12, "additional_payer_notes": "212.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medical Rental Network", "methodology": "fee schedule", "standard_charge_dollar": 1769.12, "additional_payer_notes": "212.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 834.49, "additional_payer_notes": "100.00% of Medicare Rates" } ] } ] }, { "description": "ACUTE ANXIETY & DELIRIUM STATES - SOI : 2", "code_information": [ { "code": "7562", "type": "APR-DRG" } ], "standard_charges": [ { "setting": "inpatient", "minimum": 7021.38, "maximum": 7723.52, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Better Health - Medi Medi", "methodology": "case rate", "standard_charge_dollar": 7723.52, "additional_payer_notes": "110% of State Medicaid Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Better Health Medicaid", "methodology": "case rate", "standard_charge_dollar": 7723.52, "additional_payer_notes": "110% of State Medicaid Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "case rate", "standard_charge_dollar": 7021.38, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "UBH", "plan_name": "UBH Medicaid", "methodology": "case rate", "standard_charge_dollar": 7021.38, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicaid (02/01/2023 to 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 7161.81, "additional_payer_notes": "102% of State Medicaid Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicaid", "methodology": "case rate", "standard_charge_dollar": 7021.38, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup Medicaid", "methodology": "case rate", "standard_charge_dollar": 7021.38, "additional_payer_notes": "100% of State Medicaid Rates" } ] } ] }, { "description": "Hc Assay Of Vitamin A", "code_information": [ { "code": "84590", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 79.0, "discounted_cash": 11.0, "minimum": 6.97, "maximum": 67.15, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 24.61, "additional_payer_notes": "212.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medical Rental Network", "methodology": "fee schedule", "standard_charge_dollar": 24.61, "additional_payer_notes": "212.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 11.61, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "ALLY-ALIGN (FKA SPARTAN PLAN NJ, INC.)", "plan_name": "ALLY-ALIGN (FKA SPARTAN PLAN NJ, INC.)", "methodology": "fee schedule", "standard_charge_dollar": 12.19, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Americhoice (UHC)", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 11.61, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Amerihealth", "plan_name": "Amerihealth Medicare", "methodology": "fee schedule", "standard_charge_dollar": 11.61, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 16.83, "additional_payer_notes": "Laboratory - 145.00% of Medicare Rates" }, { "payer_name": "Clover Health", "plan_name": "Clover Medicare", "methodology": "fee schedule", "standard_charge_dollar": 11.61, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Coventry", "plan_name": "Coventry Auto", "methodology": "fee schedule", "standard_charge_dollar": 23.22, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Coventry", "plan_name": "Coventry Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 23.22, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "fee schedule", "standard_charge_dollar": 16.25, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Fairprice Healthcare Holdings", "plan_name": "Fairprice Healthcare Holdings", "methodology": "fee schedule", "standard_charge_dollar": 13.93, "additional_payer_notes": "Laboratory - 120.00% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ HMO POS", "methodology": "fee schedule", "standard_charge_dollar": 55.77, "additional_payer_notes": "177.30% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ Indemnity", "methodology": "fee schedule", "standard_charge_dollar": 55.77, "additional_payer_notes": "177.30% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ PPO", "methodology": "fee schedule", "standard_charge_dollar": 55.77, "additional_payer_notes": "177.30% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon Medicare", "methodology": "fee schedule", "standard_charge_dollar": 11.61, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Military Tricare", "methodology": "fee schedule", "standard_charge_dollar": 9.29, "additional_payer_notes": "80.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 11.61, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 11.61, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC All Payer (02-01-2023 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 6.97 }, { "payer_name": "UHC", "plan_name": "UHC Medicaid (02/01/2023 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 9.29 }, { "payer_name": "UHC", "plan_name": "UHC Oxford (02-01-2023 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 6.97 }, { "payer_name": "UHC - Adhoc", "plan_name": "UHC - Adhoc All Payer", "methodology": "fee schedule", "standard_charge_dollar": 11.61 }, { "payer_name": "UHC - Adhoc", "plan_name": "UHC - Adhoc Oxford", "methodology": "fee schedule", "standard_charge_dollar": 11.61 }, { "payer_name": "Wellcare", "plan_name": "Wellcare Insurance Exchange", "methodology": "fee schedule", "standard_charge_dollar": 15.67, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 11.61, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup Medicare", "methodology": "fee schedule", "standard_charge_dollar": 11.61, "additional_payer_notes": "100.00% of Medicare Rates" } ] } ] }, { "description": "MAJOR DEPRESSIVE DISORDERS & OTHERUNSPECIFIED PSYCHOSES - SOI : 1", "code_information": [ { "code": "7511", "type": "APR-DRG" } ], "standard_charges": [ { "setting": "inpatient", "minimum": 4604.41, "maximum": 5064.85, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Better Health - Medi Medi", "methodology": "case rate", "standard_charge_dollar": 5064.85, "additional_payer_notes": "110% of State Medicaid Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Better Health Medicaid", "methodology": "case rate", "standard_charge_dollar": 5064.85, "additional_payer_notes": "110% of State Medicaid Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "case rate", "standard_charge_dollar": 4604.41, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "UBH", "plan_name": "UBH Medicaid", "methodology": "case rate", "standard_charge_dollar": 4604.41, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicaid (02/01/2023 to 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 4696.5, "additional_payer_notes": "102% of State Medicaid Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicaid", "methodology": "case rate", "standard_charge_dollar": 4604.41, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup Medicaid", "methodology": "case rate", "standard_charge_dollar": 4604.41, "additional_payer_notes": "100% of State Medicaid Rates" } ] } ] }, { "description": "ALLERGIC REACTIONS - SOI : 4", "code_information": [ { "code": "8114", "type": "APR-DRG" } ], "standard_charges": [ { "setting": "inpatient", "minimum": 24233.79, "maximum": 26657.17, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Better Health - Medi Medi", "methodology": "case rate", "standard_charge_dollar": 26657.17, "additional_payer_notes": "110% of State Medicaid Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Better Health Medicaid", "methodology": "case rate", "standard_charge_dollar": 26657.17, "additional_payer_notes": "110% of State Medicaid Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "case rate", "standard_charge_dollar": 24233.79, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "UBH", "plan_name": "UBH Medicaid", "methodology": "case rate", "standard_charge_dollar": 24233.79, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicaid (02/01/2023 to 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 24718.47, "additional_payer_notes": "102% of State Medicaid Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicaid", "methodology": "case rate", "standard_charge_dollar": 24233.79, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup Medicaid", "methodology": "case rate", "standard_charge_dollar": 24233.79, "additional_payer_notes": "100% of State Medicaid Rates" } ] } ] }, { "description": "OTHER RESPIRATORY DIAGNOSES EXCEPT SIGNS, SYMPTOMS AND MISCELLANEOUS DIAGNOSES- SOI : 4", "code_information": [ { "code": "1434", "type": "APR-DRG" } ], "standard_charges": [ { "setting": "inpatient", "minimum": 21162.02, "maximum": 23278.22, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Better Health - Medi Medi", "methodology": "case rate", "standard_charge_dollar": 23278.22, "additional_payer_notes": "110% of State Medicaid Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Better Health Medicaid", "methodology": "case rate", "standard_charge_dollar": 23278.22, "additional_payer_notes": "110% of State Medicaid Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "case rate", "standard_charge_dollar": 21162.02, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "UBH", "plan_name": "UBH Medicaid", "methodology": "case rate", "standard_charge_dollar": 21162.02, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicaid (02/01/2023 to 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 21585.26, "additional_payer_notes": "102% of State Medicaid Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicaid", "methodology": "case rate", "standard_charge_dollar": 21162.02, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup Medicaid", "methodology": "case rate", "standard_charge_dollar": 21162.02, "additional_payer_notes": "100% of State Medicaid Rates" } ] } ] }, { "description": "Hc Repr Wnd Intrmd Neck/Hnd/Ft/Gent <2.5 Cm", "code_information": [ { "code": "12041", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 1170.71, "discounted_cash": 480.0, "minimum": 223.4885, "maximum": 1170.71, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 1018.83, "additional_payer_notes": "212.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medical Rental Network", "methodology": "fee schedule", "standard_charge_dollar": 1018.83, "additional_payer_notes": "212.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 480.58, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "ALLY-ALIGN (FKA SPARTAN PLAN NJ, INC.)", "plan_name": "ALLY-ALIGN (FKA SPARTAN PLAN NJ, INC.)", "methodology": "fee schedule", "standard_charge_dollar": 504.61, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Americhoice (UHC)", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 480.58, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Amerihealth", "plan_name": "Amerihealth Medicare", "methodology": "fee schedule", "standard_charge_dollar": 480.58, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 706.21, "additional_payer_notes": "146.95% of Medicare Rates" }, { "payer_name": "Clover Health", "plan_name": "Clover Medicare", "methodology": "fee schedule", "standard_charge_dollar": 480.58, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Coventry", "plan_name": "Coventry Auto", "methodology": "fee schedule", "standard_charge_dollar": 961.16, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Coventry", "plan_name": "Coventry Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 961.16, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "fee schedule", "standard_charge_dollar": 672.81, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Fairprice Healthcare Holdings", "plan_name": "Fairprice Healthcare Holdings", "methodology": "fee schedule", "standard_charge_dollar": 768.93, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ HMO POS", "methodology": "fee schedule", "standard_charge_dollar": 852.07, "additional_payer_notes": "177.30% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ Indemnity", "methodology": "fee schedule", "standard_charge_dollar": 852.07, "additional_payer_notes": "177.30% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ PPO", "methodology": "fee schedule", "standard_charge_dollar": 852.07, "additional_payer_notes": "177.30% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon Medicare", "methodology": "fee schedule", "standard_charge_dollar": 480.58, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Military Tricare", "methodology": "fee schedule", "standard_charge_dollar": 384.46, "additional_payer_notes": "80.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 480.58, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 480.58, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC All Payer (02-01-2023 to 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 1170.71 }, { "payer_name": "UHC", "plan_name": "UHC Oxford (02-01-2023 to 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 1170.71 }, { "payer_name": "UHC - Adhoc", "plan_name": "UHC - Adhoc All Payer", "methodology": "case rate", "standard_charge_dollar": 1170.71 }, { "payer_name": "UHC - Adhoc", "plan_name": "UHC - Adhoc Oxford", "methodology": "case rate", "standard_charge_dollar": 1170.71 }, { "payer_name": "Wellcare", "plan_name": "Wellcare Insurance Exchange", "methodology": "fee schedule", "standard_charge_dollar": 648.78, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 480.58, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellchoice", "plan_name": "WELLCHOICE HMO of NJ (Empire) Commercial (HMO / HMO POS, PPO)", "methodology": "case rate", "standard_charge_dollar": 1170.71 }, { "payer_name": "Wellchoice", "plan_name": "WELLCHOICE HMO of NJ (Empire) Commercial (Indemnity)", "methodology": "case rate", "standard_charge_dollar": 1170.71 }, { "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup Medicare", "methodology": "fee schedule", "standard_charge_dollar": 480.58, "additional_payer_notes": "100.00% of Medicare Rates" } ] } ] }, { "description": "Exc H-F-Nk-Sp B9+Marg 0.5/<", "code_information": [ { "code": "11420", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 15390.0, "discounted_cash": 1952.0, "minimum": 538.9107, "maximum": 12312.0, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 4139.36, "additional_payer_notes": "212.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medical Rental Network", "methodology": "fee schedule", "standard_charge_dollar": 4139.36, "additional_payer_notes": "212.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1952.53, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "ALLY-ALIGN (FKA SPARTAN PLAN NJ, INC.)", "plan_name": "ALLY-ALIGN (FKA SPARTAN PLAN NJ, INC.)", "methodology": "fee schedule", "standard_charge_dollar": 2050.16, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Americhoice (UHC)", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1952.53, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Amerihealth", "plan_name": "Amerihealth HMO", "methodology": "percent of total billed charges", "standard_charge_percentage": 50.0, "standard_charge_algorithm": "Not To Exceed $9088", "additional_payer_notes": "Not to exceed limits in contract for this procedure", "median_amount": 5130.0, "10th_percentile": 5130.0, "90th_percentile": 5130.0, "count": "1 through 10" }, { "payer_name": "Amerihealth", "plan_name": "Amerihealth Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1952.53, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 2869.24, "additional_payer_notes": "146.95% of Medicare Rates" }, { "payer_name": "Clover Health", "plan_name": "Clover Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1952.53, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Coventry", "plan_name": "Coventry Auto", "methodology": "fee schedule", "standard_charge_dollar": 3905.06, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Coventry", "plan_name": "Coventry Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 3905.06, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "fee schedule", "standard_charge_dollar": 2733.54, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Fairprice Healthcare Holdings", "plan_name": "Fairprice Healthcare Holdings", "methodology": "fee schedule", "standard_charge_dollar": 3124.05, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ HMO POS", "methodology": "fee schedule", "standard_charge_dollar": 3461.84, "additional_payer_notes": "177.30% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ Indemnity", "methodology": "fee schedule", "standard_charge_dollar": 3461.84, "additional_payer_notes": "177.30% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ PPO", "methodology": "fee schedule", "standard_charge_dollar": 3461.84, "additional_payer_notes": "177.30% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1952.53, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon NJ Health Medicaid", "methodology": "percent of total billed charges", "standard_charge_percentage": 19.58, "median_amount": 1506.68, "10th_percentile": 502.23, "90th_percentile": 2008.91, "count": "1 through 10" }, { "payer_name": "Humana", "plan_name": "Humana Military Tricare", "methodology": "fee schedule", "standard_charge_dollar": 1562.02, "additional_payer_notes": "80.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1952.53, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 1952.53, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC All Payer (02-01-2023 to 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 3147.0 }, { "payer_name": "UHC", "plan_name": "UHC Medicaid (02/01/2023 to 12-31-2026)", "methodology": "percent of total billed charges", "standard_charge_percentage": 19.47, "median_amount": 1829.78, "10th_percentile": 1829.78, "90th_percentile": 1829.78, "count": "1 through 10" }, { "payer_name": "UHC", "plan_name": "UHC Oxford (02-01-2023 to 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 2297.0 }, { "payer_name": "UHC - Adhoc", "plan_name": "UHC - Adhoc All Payer", "methodology": "case rate", "standard_charge_dollar": 3341.0 }, { "payer_name": "UHC - Adhoc", "plan_name": "UHC - Adhoc Oxford", "methodology": "case rate", "standard_charge_dollar": 2367.0 }, { "payer_name": "Wellcare", "plan_name": "Wellcare Insurance Exchange", "methodology": "fee schedule", "standard_charge_dollar": 2635.92, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1952.53, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellchoice", "plan_name": "WELLCHOICE HMO of NJ (Empire) Commercial (HMO / HMO POS, PPO)", "methodology": "case rate", "standard_charge_dollar": 1715.0 }, { "payer_name": "Wellchoice", "plan_name": "WELLCHOICE HMO of NJ (Empire) Commercial (Indemnity)", "methodology": "case rate", "standard_charge_dollar": 1978.0 }, { "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup Medicaid", "methodology": "percent of total billed charges", "standard_charge_percentage": 19.09, "median_amount": 1913.49, "10th_percentile": 1913.49, "90th_percentile": 1913.49, "count": "1 through 10" }, { "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1952.53, "additional_payer_notes": "100.00% of Medicare Rates" } ] } ] }, { "description": "MALIGNANCY, MALE REPRODUCTIVE SYSTEM - SOI : 4", "code_information": [ { "code": "5004", "type": "APR-DRG" } ], "standard_charges": [ { "setting": "inpatient", "minimum": 23874.11, "maximum": 26261.53, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Better Health - Medi Medi", "methodology": "case rate", "standard_charge_dollar": 26261.53, "additional_payer_notes": "110% of State Medicaid Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Better Health Medicaid", "methodology": "case rate", "standard_charge_dollar": 26261.53, "additional_payer_notes": "110% of State Medicaid Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "case rate", "standard_charge_dollar": 23874.11, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "UBH", "plan_name": "UBH Medicaid", "methodology": "case rate", "standard_charge_dollar": 23874.11, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicaid (02/01/2023 to 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 24351.6, "additional_payer_notes": "102% of State Medicaid Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicaid", "methodology": "case rate", "standard_charge_dollar": 23874.11, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup Medicaid", "methodology": "case rate", "standard_charge_dollar": 23874.11, "additional_payer_notes": "100% of State Medicaid Rates" } ] } ] }, { "description": "Hc X-Ray Urethrocystogram & Voiding", "code_information": [ { "code": "74455", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 1152.8, "discounted_cash": 282.0, "minimum": 220.0695, "maximum": 979.88, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 597.99, "additional_payer_notes": "212.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medical Rental Network", "methodology": "fee schedule", "standard_charge_dollar": 597.99, "additional_payer_notes": "212.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 282.07, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "ALLY-ALIGN (FKA SPARTAN PLAN NJ, INC.)", "plan_name": "ALLY-ALIGN (FKA SPARTAN PLAN NJ, INC.)", "methodology": "fee schedule", "standard_charge_dollar": 296.17, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Americhoice (UHC)", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 282.07, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Amerihealth", "plan_name": "Amerihealth Medicare", "methodology": "fee schedule", "standard_charge_dollar": 282.07, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 414.5, "additional_payer_notes": "146.95% of Medicare Rates" }, { "payer_name": "Clover Health", "plan_name": "Clover Medicare", "methodology": "fee schedule", "standard_charge_dollar": 282.07, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Coventry", "plan_name": "Coventry Auto", "methodology": "fee schedule", "standard_charge_dollar": 564.14, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Coventry", "plan_name": "Coventry Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 564.14, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "fee schedule", "standard_charge_dollar": 394.9, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Fairprice Healthcare Holdings", "plan_name": "Fairprice Healthcare Holdings", "methodology": "fee schedule", "standard_charge_dollar": 451.31, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ HMO POS", "methodology": "fee schedule", "standard_charge_dollar": 500.11, "additional_payer_notes": "177.30% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ Indemnity", "methodology": "fee schedule", "standard_charge_dollar": 500.11, "additional_payer_notes": "177.30% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ PPO", "methodology": "fee schedule", "standard_charge_dollar": 500.11, "additional_payer_notes": "177.30% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon Medicare", "methodology": "fee schedule", "standard_charge_dollar": 282.07, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Military Tricare", "methodology": "fee schedule", "standard_charge_dollar": 225.66, "additional_payer_notes": "80.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 282.07, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 282.07, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC All Payer (02-01-2023 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 345.2 }, { "payer_name": "UHC", "plan_name": "UHC Oxford (02-01-2023 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 345.2 }, { "payer_name": "UHC - Adhoc", "plan_name": "UHC - Adhoc All Payer", "methodology": "fee schedule", "standard_charge_dollar": 230.13 }, { "payer_name": "UHC - Adhoc", "plan_name": "UHC - Adhoc Oxford", "methodology": "fee schedule", "standard_charge_dollar": 230.13 }, { "payer_name": "Wellcare", "plan_name": "Wellcare Insurance Exchange", "methodology": "fee schedule", "standard_charge_dollar": 380.79, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 282.07, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup Medicare", "methodology": "fee schedule", "standard_charge_dollar": 282.07, "additional_payer_notes": "100.00% of Medicare Rates" } ] } ] }, { "description": "Hc X-Ray Sacroiliac Jts <3 Vw", "code_information": [ { "code": "72200", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 562.55, "discounted_cash": 123.0, "minimum": 46.75, "maximum": 478.1675, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 262.01, "additional_payer_notes": "212.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medical Rental Network", "methodology": "fee schedule", "standard_charge_dollar": 262.01, "additional_payer_notes": "212.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 123.59, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "ALLY-ALIGN (FKA SPARTAN PLAN NJ, INC.)", "plan_name": "ALLY-ALIGN (FKA SPARTAN PLAN NJ, INC.)", "methodology": "fee schedule", "standard_charge_dollar": 129.77, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Americhoice (UHC)", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 123.59, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Amerihealth", "plan_name": "Amerihealth HMO", "methodology": "fee schedule", "standard_charge_dollar": 46.75 }, { "payer_name": "Amerihealth", "plan_name": "Amerihealth Medicare", "methodology": "fee schedule", "standard_charge_dollar": 123.59, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 181.62, "additional_payer_notes": "146.95% of Medicare Rates" }, { "payer_name": "Clover Health", "plan_name": "Clover Medicare", "methodology": "fee schedule", "standard_charge_dollar": 123.59, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Coventry", "plan_name": "Coventry Auto", "methodology": "fee schedule", "standard_charge_dollar": 247.18, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Coventry", "plan_name": "Coventry Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 247.18, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "fee schedule", "standard_charge_dollar": 173.03, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Fairprice Healthcare Holdings", "plan_name": "Fairprice Healthcare Holdings", "methodology": "fee schedule", "standard_charge_dollar": 197.74, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ HMO POS", "methodology": "fee schedule", "standard_charge_dollar": 219.13, "additional_payer_notes": "177.30% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ Indemnity", "methodology": "fee schedule", "standard_charge_dollar": 219.13, "additional_payer_notes": "177.30% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ PPO", "methodology": "fee schedule", "standard_charge_dollar": 219.13, "additional_payer_notes": "177.30% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon Medicare", "methodology": "fee schedule", "standard_charge_dollar": 123.59, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Military Tricare", "methodology": "fee schedule", "standard_charge_dollar": 98.87, "additional_payer_notes": "80.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 123.59, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 123.59, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC All Payer (02-01-2023 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 163.46 }, { "payer_name": "UHC", "plan_name": "UHC Oxford (02-01-2023 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 163.46 }, { "payer_name": "UHC - Adhoc", "plan_name": "UHC - Adhoc All Payer", "methodology": "fee schedule", "standard_charge_dollar": 108.97 }, { "payer_name": "UHC - Adhoc", "plan_name": "UHC - Adhoc Oxford", "methodology": "fee schedule", "standard_charge_dollar": 108.97 }, { "payer_name": "Wellcare", "plan_name": "Wellcare Insurance Exchange", "methodology": "fee schedule", "standard_charge_dollar": 166.85, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 123.59, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup Medicare", "methodology": "fee schedule", "standard_charge_dollar": 123.59, "additional_payer_notes": "100.00% of Medicare Rates" } ] } ] }, { "description": "Hc Artl Cathj/Cannulj Mntr/Transfusion Spx Cutdown", "code_information": [ { "code": "36625", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 250.0, "minimum": 47.725, "maximum": 250.0, "payers_information": [ { "payer_name": "UHC", "plan_name": "UHC All Payer (02-01-2023 to 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 250.0 }, { "payer_name": "UHC", "plan_name": "UHC Oxford (02-01-2023 to 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 250.0 }, { "payer_name": "UHC - Adhoc", "plan_name": "UHC - Adhoc All Payer", "methodology": "case rate", "standard_charge_dollar": 250.0 }, { "payer_name": "UHC - Adhoc", "plan_name": "UHC - Adhoc Oxford", "methodology": "case rate", "standard_charge_dollar": 250.0 }, { "payer_name": "Wellchoice", "plan_name": "WELLCHOICE HMO of NJ (Empire) Commercial (HMO / HMO POS, PPO)", "methodology": "case rate", "standard_charge_dollar": 250.0 }, { "payer_name": "Wellchoice", "plan_name": "WELLCHOICE HMO of NJ (Empire) Commercial (Indemnity)", "methodology": "case rate", "standard_charge_dollar": 250.0 } ] } ] }, { "description": "Hc Program Eval Implantable In Persn Dual Ld Pacer", "code_information": [ { "code": "93280", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 267.12, "discounted_cash": 44.0, "minimum": 35.288, "maximum": 267.12, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 93.51, "additional_payer_notes": "212.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medical Rental Network", "methodology": "fee schedule", "standard_charge_dollar": 93.51, "additional_payer_notes": "212.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 44.11, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "ALLY-ALIGN (FKA SPARTAN PLAN NJ, INC.)", "plan_name": "ALLY-ALIGN (FKA SPARTAN PLAN NJ, INC.)", "methodology": "fee schedule", "standard_charge_dollar": 46.32, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Americhoice (UHC)", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 44.11, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Amerihealth", "plan_name": "Amerihealth Medicare", "methodology": "fee schedule", "standard_charge_dollar": 44.11, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 64.82, "additional_payer_notes": "146.95% of Medicare Rates" }, { "payer_name": "Clover Health", "plan_name": "Clover Medicare", "methodology": "fee schedule", "standard_charge_dollar": 44.11, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Coventry", "plan_name": "Coventry Auto", "methodology": "fee schedule", "standard_charge_dollar": 88.22, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Coventry", "plan_name": "Coventry Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 88.22, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "fee schedule", "standard_charge_dollar": 61.75, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Fairprice Healthcare Holdings", "plan_name": "Fairprice Healthcare Holdings", "methodology": "fee schedule", "standard_charge_dollar": 70.58, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ HMO POS", "methodology": "fee schedule", "standard_charge_dollar": 78.21, "additional_payer_notes": "177.30% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ Indemnity", "methodology": "fee schedule", "standard_charge_dollar": 78.21, "additional_payer_notes": "177.30% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ PPO", "methodology": "fee schedule", "standard_charge_dollar": 78.21, "additional_payer_notes": "177.30% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon Medicare", "methodology": "fee schedule", "standard_charge_dollar": 44.11, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Military Tricare", "methodology": "fee schedule", "standard_charge_dollar": 35.29, "additional_payer_notes": "80.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 44.11, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 44.11, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC All Payer (02-01-2023 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 267.12 }, { "payer_name": "UHC", "plan_name": "UHC Oxford (02-01-2023 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 267.12 }, { "payer_name": "UHC - Adhoc", "plan_name": "UHC - Adhoc All Payer", "methodology": "fee schedule", "standard_charge_dollar": 267.12 }, { "payer_name": "UHC - Adhoc", "plan_name": "UHC - Adhoc Oxford", "methodology": "fee schedule", "standard_charge_dollar": 267.12 }, { "payer_name": "Wellcare", "plan_name": "Wellcare Insurance Exchange", "methodology": "fee schedule", "standard_charge_dollar": 59.55, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 44.11, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellchoice", "plan_name": "WELLCHOICE HMO of NJ (Empire) Commercial (HMO / HMO POS, PPO)", "methodology": "case rate", "standard_charge_dollar": 267.12 }, { "payer_name": "Wellchoice", "plan_name": "WELLCHOICE HMO of NJ (Empire) Commercial (Indemnity)", "methodology": "case rate", "standard_charge_dollar": 267.12 }, { "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup Medicare", "methodology": "fee schedule", "standard_charge_dollar": 44.11, "additional_payer_notes": "100.00% of Medicare Rates" } ] } ] }, { "description": "Hc Colorectal Cancer Screen, Colonoscopy High Risk - 45378 - 75000068", "code_information": [ { "code": "45378", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 3752.03, "discounted_cash": 1099.0, "minimum": 716.2625, "maximum": 3752.03, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 2330.73, "additional_payer_notes": "212.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medical Rental Network", "methodology": "fee schedule", "standard_charge_dollar": 2330.73, "additional_payer_notes": "212.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1099.4, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "ALLY-ALIGN (FKA SPARTAN PLAN NJ, INC.)", "plan_name": "ALLY-ALIGN (FKA SPARTAN PLAN NJ, INC.)", "methodology": "fee schedule", "standard_charge_dollar": 1154.37, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Americhoice (UHC)", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1099.4, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Amerihealth", "plan_name": "Amerihealth Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1099.4, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 1615.57, "additional_payer_notes": "146.95% of Medicare Rates" }, { "payer_name": "Clover Health", "plan_name": "Clover Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1099.4, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Coventry", "plan_name": "Coventry Auto", "methodology": "fee schedule", "standard_charge_dollar": 2198.8, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Coventry", "plan_name": "Coventry Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 2198.8, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "fee schedule", "standard_charge_dollar": 1539.16, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Fairprice Healthcare Holdings", "plan_name": "Fairprice Healthcare Holdings", "methodology": "fee schedule", "standard_charge_dollar": 1759.04, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ HMO POS", "methodology": "fee schedule", "standard_charge_dollar": 1949.24, "additional_payer_notes": "177.30% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ Indemnity", "methodology": "fee schedule", "standard_charge_dollar": 1949.24, "additional_payer_notes": "177.30% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ PPO", "methodology": "fee schedule", "standard_charge_dollar": 1949.24, "additional_payer_notes": "177.30% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1099.4, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon NJ Health Medicaid", "methodology": "percent of total billed charges", "standard_charge_percentage": 19.58, "median_amount": 734.65, "10th_percentile": 659.59, "90th_percentile": 734.65, "count": "64" }, { "payer_name": "Humana", "plan_name": "Humana Military Tricare", "methodology": "fee schedule", "standard_charge_dollar": 879.52, "additional_payer_notes": "80.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1099.4, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 1099.4, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC All Payer (02-01-2023 to 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 3752.03 }, { "payer_name": "UHC", "plan_name": "UHC Medicaid (02/01/2023 to 12-31-2026)", "methodology": "percent of total billed charges", "standard_charge_percentage": 19.47, "median_amount": 713.75, "10th_percentile": 640.83, "90th_percentile": 713.75, "count": "13" }, { "payer_name": "UHC", "plan_name": "UHC Oxford (02-01-2023 to 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 3676.0 }, { "payer_name": "UHC - Adhoc", "plan_name": "UHC - Adhoc All Payer", "methodology": "case rate", "standard_charge_dollar": 3752.03 }, { "payer_name": "UHC - Adhoc", "plan_name": "UHC - Adhoc Oxford", "methodology": "case rate", "standard_charge_dollar": 3752.03 }, { "payer_name": "Wellcare", "plan_name": "Wellcare Insurance Exchange", "methodology": "fee schedule", "standard_charge_dollar": 1484.19, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1099.4, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup Medicaid", "methodology": "percent of total billed charges", "standard_charge_percentage": 19.09, "median_amount": 699.75, "10th_percentile": 628.26, "90th_percentile": 699.75, "count": "14" }, { "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1099.4, "additional_payer_notes": "100.00% of Medicare Rates" } ] } ] }, { "description": "Njx Aa&/Strd Nrv Nrvtg Si Jt", "code_information": [ { "code": "64451", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 15401.3, "discounted_cash": 834.0, "minimum": 628.92, "maximum": 12321.04, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 1769.12, "additional_payer_notes": "212.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medical Rental Network", "methodology": "fee schedule", "standard_charge_dollar": 1769.12, "additional_payer_notes": "212.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 834.49, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "ALLY-ALIGN (FKA SPARTAN PLAN NJ, INC.)", "plan_name": "ALLY-ALIGN (FKA SPARTAN PLAN NJ, INC.)", "methodology": "fee schedule", "standard_charge_dollar": 876.21, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Americhoice (UHC)", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 834.49, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Amerihealth", "plan_name": "Amerihealth Medicare", "methodology": "fee schedule", "standard_charge_dollar": 834.49, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 1226.28, "additional_payer_notes": "146.95% of Medicare Rates" }, { "payer_name": "Clover Health", "plan_name": "Clover Medicare", "methodology": "fee schedule", "standard_charge_dollar": 834.49, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Coventry", "plan_name": "Coventry Auto", "methodology": "fee schedule", "standard_charge_dollar": 1668.98, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Coventry", "plan_name": "Coventry Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 1668.98, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "fee schedule", "standard_charge_dollar": 1168.29, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Fairprice Healthcare Holdings", "plan_name": "Fairprice Healthcare Holdings", "methodology": "fee schedule", "standard_charge_dollar": 1335.18, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ HMO POS", "methodology": "fee schedule", "standard_charge_dollar": 1479.55, "additional_payer_notes": "177.30% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ Indemnity", "methodology": "fee schedule", "standard_charge_dollar": 1479.55, "additional_payer_notes": "177.30% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ PPO", "methodology": "fee schedule", "standard_charge_dollar": 1479.55, "additional_payer_notes": "177.30% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon Medicare", "methodology": "fee schedule", "standard_charge_dollar": 834.49, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Military Tricare", "methodology": "fee schedule", "standard_charge_dollar": 667.59, "additional_payer_notes": "80.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 834.49, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 834.49, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC All Payer (02-01-2023 to 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 3147.0 }, { "payer_name": "UHC", "plan_name": "UHC Oxford (02-01-2023 to 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 2297.0 }, { "payer_name": "UHC - Adhoc", "plan_name": "UHC - Adhoc All Payer", "methodology": "case rate", "standard_charge_dollar": 3341.0 }, { "payer_name": "UHC - Adhoc", "plan_name": "UHC - Adhoc Oxford", "methodology": "case rate", "standard_charge_dollar": 2367.0 }, { "payer_name": "Wellcare", "plan_name": "Wellcare Insurance Exchange", "methodology": "fee schedule", "standard_charge_dollar": 1126.56, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 834.49, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellchoice", "plan_name": "WELLCHOICE HMO of NJ (Empire) Commercial (HMO / HMO POS, PPO)", "methodology": "case rate", "standard_charge_dollar": 1715.0 }, { "payer_name": "Wellchoice", "plan_name": "WELLCHOICE HMO of NJ (Empire) Commercial (Indemnity)", "methodology": "case rate", "standard_charge_dollar": 1978.0 }, { "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup Medicare", "methodology": "fee schedule", "standard_charge_dollar": 834.49, "additional_payer_notes": "100.00% of Medicare Rates" } ] } ] }, { "description": "Hc Assay Of Carotene", "code_information": [ { "code": "82380", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 51.0, "discounted_cash": 9.0, "minimum": 5.53, "maximum": 43.35, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 19.55, "additional_payer_notes": "212.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medical Rental Network", "methodology": "fee schedule", "standard_charge_dollar": 19.55, "additional_payer_notes": "212.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 9.22, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "ALLY-ALIGN (FKA SPARTAN PLAN NJ, INC.)", "plan_name": "ALLY-ALIGN (FKA SPARTAN PLAN NJ, INC.)", "methodology": "fee schedule", "standard_charge_dollar": 9.68, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Americhoice (UHC)", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 9.22, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Amerihealth", "plan_name": "Amerihealth Medicare", "methodology": "fee schedule", "standard_charge_dollar": 9.22, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 13.37, "additional_payer_notes": "Laboratory - 145.00% of Medicare Rates" }, { "payer_name": "Clover Health", "plan_name": "Clover Medicare", "methodology": "fee schedule", "standard_charge_dollar": 9.22, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Coventry", "plan_name": "Coventry Auto", "methodology": "fee schedule", "standard_charge_dollar": 18.44, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Coventry", "plan_name": "Coventry Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 18.44, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "fee schedule", "standard_charge_dollar": 12.91, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Fairprice Healthcare Holdings", "plan_name": "Fairprice Healthcare Holdings", "methodology": "fee schedule", "standard_charge_dollar": 11.06, "additional_payer_notes": "Laboratory - 120.00% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ HMO POS", "methodology": "fee schedule", "standard_charge_dollar": 36.01, "additional_payer_notes": "177.30% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ Indemnity", "methodology": "fee schedule", "standard_charge_dollar": 36.01, "additional_payer_notes": "177.30% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ PPO", "methodology": "fee schedule", "standard_charge_dollar": 36.01, "additional_payer_notes": "177.30% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon Medicare", "methodology": "fee schedule", "standard_charge_dollar": 9.22, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Military Tricare", "methodology": "fee schedule", "standard_charge_dollar": 7.38, "additional_payer_notes": "80.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 9.22, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 9.22, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC All Payer (02-01-2023 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 5.53 }, { "payer_name": "UHC", "plan_name": "UHC Medicaid (02/01/2023 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 7.38 }, { "payer_name": "UHC", "plan_name": "UHC Oxford (02-01-2023 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 5.53 }, { "payer_name": "UHC - Adhoc", "plan_name": "UHC - Adhoc All Payer", "methodology": "fee schedule", "standard_charge_dollar": 9.22 }, { "payer_name": "UHC - Adhoc", "plan_name": "UHC - Adhoc Oxford", "methodology": "fee schedule", "standard_charge_dollar": 9.22 }, { "payer_name": "Wellcare", "plan_name": "Wellcare Insurance Exchange", "methodology": "fee schedule", "standard_charge_dollar": 12.45, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 9.22, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup Medicare", "methodology": "fee schedule", "standard_charge_dollar": 9.22, "additional_payer_notes": "100.00% of Medicare Rates" } ] } ] }, { "description": "MAJOR SHOULDER OR ELBOW JOINT PROCEDURES WITHOUT CCMCC", "code_information": [ { "code": "508", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 19057.0, "minimum": 9038.05, "maximum": 34494.6904, "payers_information": [ { "payer_name": "Horizon", "plan_name": "Horizon NJ Health Medicaid", "methodology": "case rate", "standard_charge_dollar": 9038.05 }, { "payer_name": "Humana", "plan_name": "Humana Military Tricare", "methodology": "case rate", "standard_charge_dollar": 15246.27, "additional_payer_notes": "80.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 19057.84, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 18777.2 }, { "payer_name": "UBH", "plan_name": "UBH Medicare", "methodology": "case rate", "standard_charge_dollar": 15609.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC All Payer (02-01-2023 to 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 25526.73 }, { "payer_name": "UHC", "plan_name": "UHC Oxford (02-01-2023 to 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 22246.54 }, { "payer_name": "UHC - Adhoc", "plan_name": "UHC - Adhoc All Payer", "methodology": "case rate", "standard_charge_dollar": 27097.16 }, { "payer_name": "UHC - Adhoc", "plan_name": "UHC - Adhoc Oxford", "methodology": "case rate", "standard_charge_dollar": 22924.99 }, { "payer_name": "Wellcare", "plan_name": "Wellcare Insurance Exchange", "methodology": "case rate", "standard_charge_dollar": 25728.08, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "case rate", "standard_charge_dollar": 15609.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup Medicare", "methodology": "case rate", "standard_charge_dollar": 15609.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "case rate", "standard_charge_dollar": 34494.69, "additional_payer_notes": "181.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medical Rental Network", "methodology": "case rate", "standard_charge_dollar": 34494.69, "additional_payer_notes": "181.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "case rate", "standard_charge_dollar": 15609.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "ALLY-ALIGN (FKA SPARTAN PLAN NJ, INC.)", "plan_name": "ALLY-ALIGN (FKA SPARTAN PLAN NJ, INC.)", "methodology": "case rate", "standard_charge_dollar": 20010.73, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Americhoice (UHC)", "plan_name": "UHC Medicare", "methodology": "case rate", "standard_charge_dollar": 15609.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Amerihealth", "plan_name": "Amerihealth Medicare", "methodology": "case rate", "standard_charge_dollar": 15609.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Commercial", "methodology": "case rate", "standard_charge_dollar": 22155.67 }, { "payer_name": "Clover Health", "plan_name": "Clover Medicare", "methodology": "case rate", "standard_charge_dollar": 15609.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Coventry", "plan_name": "Coventry Auto", "methodology": "case rate", "standard_charge_dollar": 32398.33, "additional_payer_notes": "170.00% of Medicare Rates" }, { "payer_name": "Coventry", "plan_name": "Coventry Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 32398.33, "additional_payer_notes": "170.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "case rate", "standard_charge_dollar": 24775.19, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Fairprice Healthcare Holdings", "plan_name": "Fairprice Healthcare Holdings", "methodology": "case rate", "standard_charge_dollar": 30492.54, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon Medicare", "methodology": "case rate", "standard_charge_dollar": 15609.6, "additional_payer_notes": "100.00% of Medicare Rates" } ] } ] }, { "description": "OPTX ACRCLV DSLC AQCHRN GRF", "code_information": [ { "code": "23552", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 6816.6, "discounted_cash": 8578.0, "minimum": 1301.2889, "maximum": 6816.6, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 6816.6, "additional_payer_notes": "212.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medical Rental Network", "methodology": "fee schedule", "standard_charge_dollar": 6816.6, "additional_payer_notes": "212.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 6816.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "ALLY-ALIGN (FKA SPARTAN PLAN NJ, INC.)", "plan_name": "ALLY-ALIGN (FKA SPARTAN PLAN NJ, INC.)", "methodology": "fee schedule", "standard_charge_dollar": 6816.6, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Americhoice (UHC)", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 6816.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Amerihealth", "plan_name": "Amerihealth Medicare", "methodology": "fee schedule", "standard_charge_dollar": 6816.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 6816.6, "additional_payer_notes": "146.95% of Medicare Rates" }, { "payer_name": "Clover Health", "plan_name": "Clover Medicare", "methodology": "fee schedule", "standard_charge_dollar": 6816.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Coventry", "plan_name": "Coventry Auto", "methodology": "fee schedule", "standard_charge_dollar": 6816.6, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Coventry", "plan_name": "Coventry Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 6816.6, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "fee schedule", "standard_charge_dollar": 6816.6, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Fairprice Healthcare Holdings", "plan_name": "Fairprice Healthcare Holdings", "methodology": "fee schedule", "standard_charge_dollar": 6816.6, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ HMO POS", "methodology": "fee schedule", "standard_charge_dollar": 6816.6, "additional_payer_notes": "177.30% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ Indemnity", "methodology": "fee schedule", "standard_charge_dollar": 6816.6, "additional_payer_notes": "177.30% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ PPO", "methodology": "fee schedule", "standard_charge_dollar": 6816.6, "additional_payer_notes": "177.30% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon Medicare", "methodology": "fee schedule", "standard_charge_dollar": 6816.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Military Tricare", "methodology": "fee schedule", "standard_charge_dollar": 6816.6, "additional_payer_notes": "80.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 6816.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 6816.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC All Payer (02-01-2023 to 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 6624.0 }, { "payer_name": "UHC", "plan_name": "UHC Oxford (02-01-2023 to 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 6317.0 }, { "payer_name": "UHC - Adhoc", "plan_name": "UHC - Adhoc All Payer", "methodology": "case rate", "standard_charge_dollar": 6816.6 }, { "payer_name": "UHC - Adhoc", "plan_name": "UHC - Adhoc Oxford", "methodology": "case rate", "standard_charge_dollar": 6510.0 }, { "payer_name": "Wellcare", "plan_name": "Wellcare Insurance Exchange", "methodology": "fee schedule", "standard_charge_dollar": 6816.6, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 6816.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellchoice", "plan_name": "WELLCHOICE HMO of NJ (Empire) Commercial (HMO / HMO POS, PPO)", "methodology": "case rate", "standard_charge_dollar": 1715.0 }, { "payer_name": "Wellchoice", "plan_name": "WELLCHOICE HMO of NJ (Empire) Commercial (Indemnity)", "methodology": "case rate", "standard_charge_dollar": 1978.0 }, { "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup Medicare", "methodology": "fee schedule", "standard_charge_dollar": 6816.6, "additional_payer_notes": "100.00% of Medicare Rates" } ] } ] }, { "description": "VAGINAL DELIVERY W COMPLICATING PROCEDURES EXC STERILIZATION &OR D&C - SOI : 2", "code_information": [ { "code": "5422", "type": "APR-DRG" } ], "standard_charges": [ { "setting": "inpatient", "minimum": 5787.74, "maximum": 6366.51, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Better Health - Medi Medi", "methodology": "case rate", "standard_charge_dollar": 6366.51, "additional_payer_notes": "110% of State Medicaid Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Better Health Medicaid", "methodology": "case rate", "standard_charge_dollar": 6366.51, "additional_payer_notes": "110% of State Medicaid Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "case rate", "standard_charge_dollar": 5787.74, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "UBH", "plan_name": "UBH Medicaid", "methodology": "case rate", "standard_charge_dollar": 5787.74, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicaid (02/01/2023 to 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 5903.49, "additional_payer_notes": "102% of State Medicaid Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicaid", "methodology": "case rate", "standard_charge_dollar": 5787.74, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup Medicaid", "methodology": "case rate", "standard_charge_dollar": 5787.74, "additional_payer_notes": "100% of State Medicaid Rates" } ] } ] }, { "description": "Hc Ex For Speech Device Rx Init Hr", "code_information": [ { "code": "92607", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 716.15, "discounted_cash": 135.0, "minimum": 108.624, "maximum": 608.7275, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 287.85, "additional_payer_notes": "212.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medical Rental Network", "methodology": "fee schedule", "standard_charge_dollar": 287.85, "additional_payer_notes": "212.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 135.78, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "ALLY-ALIGN (FKA SPARTAN PLAN NJ, INC.)", "plan_name": "ALLY-ALIGN (FKA SPARTAN PLAN NJ, INC.)", "methodology": "fee schedule", "standard_charge_dollar": 142.57, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Americhoice (UHC)", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 135.78, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Amerihealth", "plan_name": "Amerihealth Medicare", "methodology": "fee schedule", "standard_charge_dollar": 135.78, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 210.46, "additional_payer_notes": "A Indicator - 155.00% of Medicare Rates" }, { "payer_name": "Clover Health", "plan_name": "Clover Medicare", "methodology": "fee schedule", "standard_charge_dollar": 135.78, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Coventry", "plan_name": "Coventry Auto", "methodology": "fee schedule", "standard_charge_dollar": 271.56, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Coventry", "plan_name": "Coventry Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 271.56, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "fee schedule", "standard_charge_dollar": 190.09, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Fairprice Healthcare Holdings", "plan_name": "Fairprice Healthcare Holdings", "methodology": "fee schedule", "standard_charge_dollar": 217.25 }, { "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ HMO POS", "methodology": "fee schedule", "standard_charge_dollar": 505.6, "additional_payer_notes": "177.30% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ Indemnity", "methodology": "fee schedule", "standard_charge_dollar": 505.6, "additional_payer_notes": "177.30% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ PPO", "methodology": "fee schedule", "standard_charge_dollar": 505.6, "additional_payer_notes": "177.30% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon Medicare", "methodology": "fee schedule", "standard_charge_dollar": 135.78, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Military Tricare", "methodology": "fee schedule", "standard_charge_dollar": 108.62, "additional_payer_notes": "80.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 135.78, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 135.78, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC All Payer (02-01-2023 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 407.0 }, { "payer_name": "UHC", "plan_name": "UHC Oxford (02-01-2023 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 357.0 }, { "payer_name": "UHC - Adhoc", "plan_name": "UHC - Adhoc All Payer", "methodology": "fee schedule", "standard_charge_dollar": 432.0 }, { "payer_name": "UHC - Adhoc", "plan_name": "UHC - Adhoc Oxford", "methodology": "fee schedule", "standard_charge_dollar": 368.0 }, { "payer_name": "Wellcare", "plan_name": "Wellcare Insurance Exchange", "methodology": "fee schedule", "standard_charge_dollar": 183.3, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 135.78, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup Medicare", "methodology": "fee schedule", "standard_charge_dollar": 135.78, "additional_payer_notes": "100.00% of Medicare Rates" } ] } ] }, { "description": "OTHER ENDOVASCULAR CARDIAC VALVE PROCEDURES WITHOUT MCC", "code_information": [ { "code": "320", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 29353.0, "minimum": 23482.8, "maximum": 53129.835, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "case rate", "standard_charge_dollar": 53129.84, "additional_payer_notes": "181.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medical Rental Network", "methodology": "case rate", "standard_charge_dollar": 53129.84, "additional_payer_notes": "181.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "case rate", "standard_charge_dollar": 23876.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "ALLY-ALIGN (FKA SPARTAN PLAN NJ, INC.)", "plan_name": "ALLY-ALIGN (FKA SPARTAN PLAN NJ, INC.)", "methodology": "case rate", "standard_charge_dollar": 30821.18, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Americhoice (UHC)", "plan_name": "UHC Medicare", "methodology": "case rate", "standard_charge_dollar": 23876.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Amerihealth", "plan_name": "Amerihealth Medicare", "methodology": "case rate", "standard_charge_dollar": 23876.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Commercial", "methodology": "case rate", "standard_charge_dollar": 35189.54 }, { "payer_name": "Clover Health", "plan_name": "Clover Medicare", "methodology": "case rate", "standard_charge_dollar": 23876.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Coventry", "plan_name": "Coventry Auto", "methodology": "case rate", "standard_charge_dollar": 49900.95, "additional_payer_notes": "170.00% of Medicare Rates" }, { "payer_name": "Coventry", "plan_name": "Coventry Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 49900.95, "additional_payer_notes": "170.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "case rate", "standard_charge_dollar": 38159.55, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Fairprice Healthcare Holdings", "plan_name": "Fairprice Healthcare Holdings", "methodology": "case rate", "standard_charge_dollar": 46965.6, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon Medicare", "methodology": "case rate", "standard_charge_dollar": 23876.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Military Tricare", "methodology": "case rate", "standard_charge_dollar": 23482.8, "additional_payer_notes": "80.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 29353.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 33677.4 }, { "payer_name": "UBH", "plan_name": "UBH Medicare", "methodology": "case rate", "standard_charge_dollar": 23876.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC All Payer (02-01-2023 to 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 40543.74 }, { "payer_name": "UHC", "plan_name": "UHC Oxford (02-01-2023 to 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 35333.86 }, { "payer_name": "UHC - Adhoc", "plan_name": "UHC - Adhoc All Payer", "methodology": "case rate", "standard_charge_dollar": 43038.03 }, { "payer_name": "UHC - Adhoc", "plan_name": "UHC - Adhoc Oxford", "methodology": "case rate", "standard_charge_dollar": 36411.43 }, { "payer_name": "Wellcare", "plan_name": "Wellcare Insurance Exchange", "methodology": "case rate", "standard_charge_dollar": 39627.23, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "case rate", "standard_charge_dollar": 23876.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup Medicare", "methodology": "case rate", "standard_charge_dollar": 23876.8, "additional_payer_notes": "100.00% of Medicare Rates" } ] } ] }, { "description": "Removal Of Breast Lesion", "code_information": [ { "code": "19120", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 22975.7, "discounted_cash": 4628.0, "minimum": 1715.0, "maximum": 18380.56, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 9813.14, "additional_payer_notes": "212.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medical Rental Network", "methodology": "fee schedule", "standard_charge_dollar": 9813.14, "additional_payer_notes": "212.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 4628.84, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "ALLY-ALIGN (FKA SPARTAN PLAN NJ, INC.)", "plan_name": "ALLY-ALIGN (FKA SPARTAN PLAN NJ, INC.)", "methodology": "fee schedule", "standard_charge_dollar": 4860.28, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Americhoice (UHC)", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 4628.84, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Amerihealth", "plan_name": "Amerihealth Medicare", "methodology": "fee schedule", "standard_charge_dollar": 4628.84, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 6802.08, "additional_payer_notes": "146.95% of Medicare Rates" }, { "payer_name": "Clover Health", "plan_name": "Clover Medicare", "methodology": "fee schedule", "standard_charge_dollar": 4628.84, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Coventry", "plan_name": "Coventry Auto", "methodology": "fee schedule", "standard_charge_dollar": 9257.68, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Coventry", "plan_name": "Coventry Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 9257.68, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "fee schedule", "standard_charge_dollar": 6480.38, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Fairprice Healthcare Holdings", "plan_name": "Fairprice Healthcare Holdings", "methodology": "fee schedule", "standard_charge_dollar": 7406.14, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ HMO POS", "methodology": "fee schedule", "standard_charge_dollar": 8206.93, "additional_payer_notes": "177.30% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ Indemnity", "methodology": "fee schedule", "standard_charge_dollar": 8206.93, "additional_payer_notes": "177.30% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ PPO", "methodology": "fee schedule", "standard_charge_dollar": 8206.93, "additional_payer_notes": "177.30% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon Medicare", "methodology": "fee schedule", "standard_charge_dollar": 4628.84, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon NJ Health Medicaid", "methodology": "percent of total billed charges", "standard_charge_percentage": 19.58, "median_amount": 4236.62, "10th_percentile": 4236.62, "90th_percentile": 4236.62, "count": "1 through 10" }, { "payer_name": "Humana", "plan_name": "Humana Military Tricare", "methodology": "fee schedule", "standard_charge_dollar": 3703.07, "additional_payer_notes": "80.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 4628.84, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 4628.84, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC All Payer (02-01-2023 to 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 4415.0 }, { "payer_name": "UHC", "plan_name": "UHC Oxford (02-01-2023 to 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 4020.0 }, { "payer_name": "UHC - Adhoc", "plan_name": "UHC - Adhoc All Payer", "methodology": "case rate", "standard_charge_dollar": 4687.0 }, { "payer_name": "UHC - Adhoc", "plan_name": "UHC - Adhoc Oxford", "methodology": "case rate", "standard_charge_dollar": 4143.0 }, { "payer_name": "Wellcare", "plan_name": "Wellcare Insurance Exchange", "methodology": "fee schedule", "standard_charge_dollar": 6248.93, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 4628.84, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellchoice", "plan_name": "WELLCHOICE HMO of NJ (Empire) Commercial (HMO / HMO POS, PPO)", "methodology": "case rate", "standard_charge_dollar": 1715.0 }, { "payer_name": "Wellchoice", "plan_name": "WELLCHOICE HMO of NJ (Empire) Commercial (Indemnity)", "methodology": "case rate", "standard_charge_dollar": 1978.0 }, { "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup Medicare", "methodology": "fee schedule", "standard_charge_dollar": 4628.84, "additional_payer_notes": "100.00% of Medicare Rates" } ] } ] }, { "description": "OTHER O.R. PROCEDURES FOR MULTIPLE SIGNIFICANT TRAUMA WITHOUT CCMCC", "code_information": [ { "code": "959", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 35580.0, "minimum": 15302.99, "maximum": 64400.0172, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "case rate", "standard_charge_dollar": 64400.02, "additional_payer_notes": "181.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medical Rental Network", "methodology": "case rate", "standard_charge_dollar": 64400.02, "additional_payer_notes": "181.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "case rate", "standard_charge_dollar": 28876.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "ALLY-ALIGN (FKA SPARTAN PLAN NJ, INC.)", "plan_name": "ALLY-ALIGN (FKA SPARTAN PLAN NJ, INC.)", "methodology": "case rate", "standard_charge_dollar": 37359.13, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Americhoice (UHC)", "plan_name": "UHC Medicare", "methodology": "case rate", "standard_charge_dollar": 28876.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Amerihealth", "plan_name": "Amerihealth Medicare", "methodology": "case rate", "standard_charge_dollar": 28876.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Commercial", "methodology": "case rate", "standard_charge_dollar": 43072.18 }, { "payer_name": "Clover Health", "plan_name": "Clover Medicare", "methodology": "case rate", "standard_charge_dollar": 28876.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Coventry", "plan_name": "Coventry Auto", "methodology": "case rate", "standard_charge_dollar": 60486.2, "additional_payer_notes": "170.00% of Medicare Rates" }, { "payer_name": "Coventry", "plan_name": "Coventry Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 60486.2, "additional_payer_notes": "170.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "case rate", "standard_charge_dollar": 46254.16, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Fairprice Healthcare Holdings", "plan_name": "Fairprice Healthcare Holdings", "methodology": "case rate", "standard_charge_dollar": 56928.19, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon Medicare", "methodology": "case rate", "standard_charge_dollar": 28876.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon NJ Health Medicaid", "methodology": "case rate", "standard_charge_dollar": 15302.99 }, { "payer_name": "Humana", "plan_name": "Humana Military Tricare", "methodology": "case rate", "standard_charge_dollar": 28464.1, "additional_payer_notes": "80.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 35580.12, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 22736.9 }, { "payer_name": "UBH", "plan_name": "UBH Medicare", "methodology": "case rate", "standard_charge_dollar": 28876.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC All Payer (02-01-2023 to 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 49625.75 }, { "payer_name": "UHC", "plan_name": "UHC Oxford (02-01-2023 to 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 43248.83 }, { "payer_name": "UHC - Adhoc", "plan_name": "UHC - Adhoc All Payer", "methodology": "case rate", "standard_charge_dollar": 52678.78 }, { "payer_name": "UHC - Adhoc", "plan_name": "UHC - Adhoc Oxford", "methodology": "case rate", "standard_charge_dollar": 44567.79 }, { "payer_name": "Wellcare", "plan_name": "Wellcare Insurance Exchange", "methodology": "case rate", "standard_charge_dollar": 48033.16, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "case rate", "standard_charge_dollar": 28876.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup Medicare", "methodology": "case rate", "standard_charge_dollar": 28876.6, "additional_payer_notes": "100.00% of Medicare Rates" } ] } ] }, { "description": "Hc Esophagoscopy Flex Removal Foreign Body", "code_information": [ { "code": "43215", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 7811.63, "discounted_cash": 2268.0, "minimum": 1491.2402, "maximum": 6639.8855, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 4809.3, "additional_payer_notes": "212.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medical Rental Network", "methodology": "fee schedule", "standard_charge_dollar": 4809.3, "additional_payer_notes": "212.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2268.54, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "ALLY-ALIGN (FKA SPARTAN PLAN NJ, INC.)", "plan_name": "ALLY-ALIGN (FKA SPARTAN PLAN NJ, INC.)", "methodology": "fee schedule", "standard_charge_dollar": 2381.97, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Americhoice (UHC)", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2268.54, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Amerihealth", "plan_name": "Amerihealth Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2268.54, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 3333.62, "additional_payer_notes": "146.95% of Medicare Rates" }, { "payer_name": "Clover Health", "plan_name": "Clover Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2268.54, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Coventry", "plan_name": "Coventry Auto", "methodology": "fee schedule", "standard_charge_dollar": 4537.08, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Coventry", "plan_name": "Coventry Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 4537.08, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "fee schedule", "standard_charge_dollar": 3175.96, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Fairprice Healthcare Holdings", "plan_name": "Fairprice Healthcare Holdings", "methodology": "fee schedule", "standard_charge_dollar": 3629.66, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ HMO POS", "methodology": "fee schedule", "standard_charge_dollar": 4022.12, "additional_payer_notes": "177.30% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ Indemnity", "methodology": "fee schedule", "standard_charge_dollar": 4022.12, "additional_payer_notes": "177.30% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ PPO", "methodology": "fee schedule", "standard_charge_dollar": 4022.12, "additional_payer_notes": "177.30% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2268.54, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Military Tricare", "methodology": "fee schedule", "standard_charge_dollar": 1814.83, "additional_payer_notes": "80.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2268.54, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 2268.54, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC All Payer (02-01-2023 to 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 3912.0 }, { "payer_name": "UHC", "plan_name": "UHC Oxford (02-01-2023 to 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 3676.0 }, { "payer_name": "UHC - Adhoc", "plan_name": "UHC - Adhoc All Payer", "methodology": "case rate", "standard_charge_dollar": 4153.0 }, { "payer_name": "UHC - Adhoc", "plan_name": "UHC - Adhoc Oxford", "methodology": "case rate", "standard_charge_dollar": 3788.0 }, { "payer_name": "Wellcare", "plan_name": "Wellcare Insurance Exchange", "methodology": "fee schedule", "standard_charge_dollar": 3062.53, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2268.54, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2268.54, "additional_payer_notes": "100.00% of Medicare Rates" } ] } ] }, { "description": "Hc Bartonella Dna Amp Probe", "code_information": [ { "code": "87471", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 209.0, "discounted_cash": 35.0, "minimum": 21.05, "maximum": 177.65, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 74.39, "additional_payer_notes": "212.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medical Rental Network", "methodology": "fee schedule", "standard_charge_dollar": 74.39, "additional_payer_notes": "212.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 35.09, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "ALLY-ALIGN (FKA SPARTAN PLAN NJ, INC.)", "plan_name": "ALLY-ALIGN (FKA SPARTAN PLAN NJ, INC.)", "methodology": "fee schedule", "standard_charge_dollar": 36.84, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Americhoice (UHC)", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 35.09, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Amerihealth", "plan_name": "Amerihealth Medicare", "methodology": "fee schedule", "standard_charge_dollar": 35.09, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 50.88, "additional_payer_notes": "Laboratory - 145.00% of Medicare Rates" }, { "payer_name": "Clover Health", "plan_name": "Clover Medicare", "methodology": "fee schedule", "standard_charge_dollar": 35.09, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Coventry", "plan_name": "Coventry Auto", "methodology": "fee schedule", "standard_charge_dollar": 70.18, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Coventry", "plan_name": "Coventry Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 70.18, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "fee schedule", "standard_charge_dollar": 49.13, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Fairprice Healthcare Holdings", "plan_name": "Fairprice Healthcare Holdings", "methodology": "fee schedule", "standard_charge_dollar": 42.11, "additional_payer_notes": "Laboratory - 120.00% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ HMO POS", "methodology": "fee schedule", "standard_charge_dollar": 147.55, "additional_payer_notes": "177.30% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ Indemnity", "methodology": "fee schedule", "standard_charge_dollar": 147.55, "additional_payer_notes": "177.30% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ PPO", "methodology": "fee schedule", "standard_charge_dollar": 147.55, "additional_payer_notes": "177.30% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon Medicare", "methodology": "fee schedule", "standard_charge_dollar": 35.09, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Military Tricare", "methodology": "fee schedule", "standard_charge_dollar": 28.07, "additional_payer_notes": "80.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 35.09, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 35.09, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC All Payer (02-01-2023 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 21.05 }, { "payer_name": "UHC", "plan_name": "UHC Medicaid (02/01/2023 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 28.07 }, { "payer_name": "UHC", "plan_name": "UHC Oxford (02-01-2023 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 21.05 }, { "payer_name": "UHC - Adhoc", "plan_name": "UHC - Adhoc All Payer", "methodology": "fee schedule", "standard_charge_dollar": 35.09 }, { "payer_name": "UHC - Adhoc", "plan_name": "UHC - Adhoc Oxford", "methodology": "fee schedule", "standard_charge_dollar": 35.09 }, { "payer_name": "Wellcare", "plan_name": "Wellcare Insurance Exchange", "methodology": "fee schedule", "standard_charge_dollar": 47.37, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 35.09, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup Medicare", "methodology": "fee schedule", "standard_charge_dollar": 35.09, "additional_payer_notes": "100.00% of Medicare Rates" } ] } ] }, { "description": "Removegraft foot lesion - 28106 - ", "code_information": [ { "code": "28106", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 10818.75, "discounted_cash": 8578.0, "minimum": 1715.0, "maximum": 10818.75, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 10818.75, "additional_payer_notes": "212.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medical Rental Network", "methodology": "fee schedule", "standard_charge_dollar": 10818.75, "additional_payer_notes": "212.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 8578.33, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "ALLY-ALIGN (FKA SPARTAN PLAN NJ, INC.)", "plan_name": "ALLY-ALIGN (FKA SPARTAN PLAN NJ, INC.)", "methodology": "fee schedule", "standard_charge_dollar": 9007.25, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Americhoice (UHC)", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 8578.33, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Amerihealth", "plan_name": "Amerihealth Medicare", "methodology": "fee schedule", "standard_charge_dollar": 8578.33, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 10818.75, "additional_payer_notes": "146.95% of Medicare Rates" }, { "payer_name": "Clover Health", "plan_name": "Clover Medicare", "methodology": "fee schedule", "standard_charge_dollar": 8578.33, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Coventry", "plan_name": "Coventry Auto", "methodology": "fee schedule", "standard_charge_dollar": 10818.75, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Coventry", "plan_name": "Coventry Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 10818.75, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "fee schedule", "standard_charge_dollar": 10818.75, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Fairprice Healthcare Holdings", "plan_name": "Fairprice Healthcare Holdings", "methodology": "fee schedule", "standard_charge_dollar": 10818.75, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ HMO POS", "methodology": "fee schedule", "standard_charge_dollar": 10818.75, "additional_payer_notes": "177.30% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ Indemnity", "methodology": "fee schedule", "standard_charge_dollar": 10818.75, "additional_payer_notes": "177.30% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ PPO", "methodology": "fee schedule", "standard_charge_dollar": 10818.75, "additional_payer_notes": "177.30% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon Medicare", "methodology": "fee schedule", "standard_charge_dollar": 8578.33, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Military Tricare", "methodology": "fee schedule", "standard_charge_dollar": 6862.66, "additional_payer_notes": "80.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 8578.33, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 8578.33, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC All Payer (02-01-2023 to 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 6624.0 }, { "payer_name": "UHC", "plan_name": "UHC Oxford (02-01-2023 to 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 6317.0 }, { "payer_name": "UHC - Adhoc", "plan_name": "UHC - Adhoc All Payer", "methodology": "case rate", "standard_charge_dollar": 7031.0 }, { "payer_name": "UHC - Adhoc", "plan_name": "UHC - Adhoc Oxford", "methodology": "case rate", "standard_charge_dollar": 6510.0 }, { "payer_name": "Wellcare", "plan_name": "Wellcare Insurance Exchange", "methodology": "fee schedule", "standard_charge_dollar": 10818.75, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 8578.33, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellchoice", "plan_name": "WELLCHOICE HMO of NJ (Empire) Commercial (HMO / HMO POS, PPO)", "methodology": "case rate", "standard_charge_dollar": 1715.0 }, { "payer_name": "Wellchoice", "plan_name": "WELLCHOICE HMO of NJ (Empire) Commercial (Indemnity)", "methodology": "case rate", "standard_charge_dollar": 1978.0 }, { "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup Medicare", "methodology": "fee schedule", "standard_charge_dollar": 8578.33, "additional_payer_notes": "100.00% of Medicare Rates" } ] } ] }, { "description": "OTHER VASCULAR PROCEDURES WITH MCC", "code_information": [ { "code": "252", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 41869.0, "minimum": 20355.28, "maximum": 75783.1615, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "case rate", "standard_charge_dollar": 75783.16, "additional_payer_notes": "181.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medical Rental Network", "methodology": "case rate", "standard_charge_dollar": 75783.16, "additional_payer_notes": "181.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "case rate", "standard_charge_dollar": 33926.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "ALLY-ALIGN (FKA SPARTAN PLAN NJ, INC.)", "plan_name": "ALLY-ALIGN (FKA SPARTAN PLAN NJ, INC.)", "methodology": "case rate", "standard_charge_dollar": 43962.61, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Americhoice (UHC)", "plan_name": "UHC Medicare", "methodology": "case rate", "standard_charge_dollar": 33926.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Amerihealth", "plan_name": "Amerihealth Medicare", "methodology": "case rate", "standard_charge_dollar": 33926.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Commercial", "methodology": "case rate", "standard_charge_dollar": 51033.83 }, { "payer_name": "Clover Health", "plan_name": "Clover Medicare", "methodology": "case rate", "standard_charge_dollar": 33926.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Coventry", "plan_name": "Coventry Auto", "methodology": "case rate", "standard_charge_dollar": 71177.56, "additional_payer_notes": "170.00% of Medicare Rates" }, { "payer_name": "Coventry", "plan_name": "Coventry Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 71177.56, "additional_payer_notes": "170.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "case rate", "standard_charge_dollar": 54429.9, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Fairprice Healthcare Holdings", "plan_name": "Fairprice Healthcare Holdings", "methodology": "case rate", "standard_charge_dollar": 66990.64, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon Medicare", "methodology": "case rate", "standard_charge_dollar": 33926.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon NJ Health Medicaid", "methodology": "case rate", "standard_charge_dollar": 20355.28 }, { "payer_name": "Humana", "plan_name": "Humana Military Tricare", "methodology": "case rate", "standard_charge_dollar": 33495.32, "additional_payer_notes": "80.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 41869.15, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 41910.0 }, { "payer_name": "UBH", "plan_name": "UBH Medicare", "methodology": "case rate", "standard_charge_dollar": 33926.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC All Payer (02-01-2023 to 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 58798.78 }, { "payer_name": "UHC", "plan_name": "UHC Oxford (02-01-2023 to 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 51243.13 }, { "payer_name": "UHC - Adhoc", "plan_name": "UHC - Adhoc All Payer", "methodology": "case rate", "standard_charge_dollar": 62416.15 }, { "payer_name": "UHC - Adhoc", "plan_name": "UHC - Adhoc Oxford", "methodology": "case rate", "standard_charge_dollar": 52805.89 }, { "payer_name": "Wellcare", "plan_name": "Wellcare Insurance Exchange", "methodology": "case rate", "standard_charge_dollar": 56523.35, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "case rate", "standard_charge_dollar": 33926.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup Medicare", "methodology": "case rate", "standard_charge_dollar": 33926.5, "additional_payer_notes": "100.00% of Medicare Rates" } ] } ] }, { "description": "VEIN LIGATION AND STRIPPING", "code_information": [ { "code": "263", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 36889.0, "minimum": 14937.7, "maximum": 66769.9407, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "case rate", "standard_charge_dollar": 66769.94, "additional_payer_notes": "181.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medical Rental Network", "methodology": "case rate", "standard_charge_dollar": 66769.94, "additional_payer_notes": "181.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "case rate", "standard_charge_dollar": 29928.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "ALLY-ALIGN (FKA SPARTAN PLAN NJ, INC.)", "plan_name": "ALLY-ALIGN (FKA SPARTAN PLAN NJ, INC.)", "methodology": "case rate", "standard_charge_dollar": 38733.94, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Americhoice (UHC)", "plan_name": "UHC Medicare", "methodology": "case rate", "standard_charge_dollar": 29928.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Amerihealth", "plan_name": "Amerihealth Medicare", "methodology": "case rate", "standard_charge_dollar": 29928.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Commercial", "methodology": "case rate", "standard_charge_dollar": 44729.76 }, { "payer_name": "Clover Health", "plan_name": "Clover Medicare", "methodology": "case rate", "standard_charge_dollar": 29928.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Coventry", "plan_name": "Coventry Auto", "methodology": "case rate", "standard_charge_dollar": 62712.1, "additional_payer_notes": "170.00% of Medicare Rates" }, { "payer_name": "Coventry", "plan_name": "Coventry Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 62712.1, "additional_payer_notes": "170.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "case rate", "standard_charge_dollar": 47956.31, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Fairprice Healthcare Holdings", "plan_name": "Fairprice Healthcare Holdings", "methodology": "case rate", "standard_charge_dollar": 59023.15, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon Medicare", "methodology": "case rate", "standard_charge_dollar": 29928.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon NJ Health Medicaid", "methodology": "case rate", "standard_charge_dollar": 14937.7 }, { "payer_name": "Humana", "plan_name": "Humana Military Tricare", "methodology": "case rate", "standard_charge_dollar": 29511.58, "additional_payer_notes": "80.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 36889.47, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 39021.2 }, { "payer_name": "UBH", "plan_name": "UBH Medicare", "methodology": "case rate", "standard_charge_dollar": 29928.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC All Payer (02-01-2023 to 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 51535.53 }, { "payer_name": "UHC", "plan_name": "UHC Oxford (02-01-2023 to 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 44913.21 }, { "payer_name": "UHC - Adhoc", "plan_name": "UHC - Adhoc All Payer", "methodology": "case rate", "standard_charge_dollar": 54706.06 }, { "payer_name": "UHC - Adhoc", "plan_name": "UHC - Adhoc Oxford", "methodology": "case rate", "standard_charge_dollar": 46282.92 }, { "payer_name": "Wellcare", "plan_name": "Wellcare Insurance Exchange", "methodology": "case rate", "standard_charge_dollar": 49800.78, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "case rate", "standard_charge_dollar": 29928.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup Medicare", "methodology": "case rate", "standard_charge_dollar": 29928.0, "additional_payer_notes": "100.00% of Medicare Rates" } ] } ] }, { "description": "Hc Assay Of Pyruvate", "code_information": [ { "code": "84210", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 34.0, "discounted_cash": 14.0, "minimum": 6.4906, "maximum": 30.6976, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 30.7, "additional_payer_notes": "212.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medical Rental Network", "methodology": "fee schedule", "standard_charge_dollar": 30.7, "additional_payer_notes": "212.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 14.48, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "ALLY-ALIGN (FKA SPARTAN PLAN NJ, INC.)", "plan_name": "ALLY-ALIGN (FKA SPARTAN PLAN NJ, INC.)", "methodology": "fee schedule", "standard_charge_dollar": 15.2, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Americhoice (UHC)", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 14.48, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Amerihealth", "plan_name": "Amerihealth Medicare", "methodology": "fee schedule", "standard_charge_dollar": 14.48, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 21.0, "additional_payer_notes": "Laboratory - 145.00% of Medicare Rates" }, { "payer_name": "Clover Health", "plan_name": "Clover Medicare", "methodology": "fee schedule", "standard_charge_dollar": 14.48, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Coventry", "plan_name": "Coventry Auto", "methodology": "fee schedule", "standard_charge_dollar": 28.96, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Coventry", "plan_name": "Coventry Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 28.96, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "fee schedule", "standard_charge_dollar": 20.27, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Fairprice Healthcare Holdings", "plan_name": "Fairprice Healthcare Holdings", "methodology": "fee schedule", "standard_charge_dollar": 17.38, "additional_payer_notes": "Laboratory - 120.00% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ HMO POS", "methodology": "fee schedule", "standard_charge_dollar": 24.0, "additional_payer_notes": "177.30% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ Indemnity", "methodology": "fee schedule", "standard_charge_dollar": 24.0, "additional_payer_notes": "177.30% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ PPO", "methodology": "fee schedule", "standard_charge_dollar": 24.0, "additional_payer_notes": "177.30% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon Medicare", "methodology": "fee schedule", "standard_charge_dollar": 14.48, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Military Tricare", "methodology": "fee schedule", "standard_charge_dollar": 11.58, "additional_payer_notes": "80.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 14.48, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 14.48, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC All Payer (02-01-2023 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 8.69 }, { "payer_name": "UHC", "plan_name": "UHC Medicaid (02/01/2023 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 11.58 }, { "payer_name": "UHC", "plan_name": "UHC Oxford (02-01-2023 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 8.69 }, { "payer_name": "UHC - Adhoc", "plan_name": "UHC - Adhoc All Payer", "methodology": "fee schedule", "standard_charge_dollar": 14.48 }, { "payer_name": "UHC - Adhoc", "plan_name": "UHC - Adhoc Oxford", "methodology": "fee schedule", "standard_charge_dollar": 14.48 }, { "payer_name": "Wellcare", "plan_name": "Wellcare Insurance Exchange", "methodology": "fee schedule", "standard_charge_dollar": 19.55, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 14.48, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup Medicare", "methodology": "fee schedule", "standard_charge_dollar": 14.48, "additional_payer_notes": "100.00% of Medicare Rates" } ] } ] }, { "description": "Treat Big Toe Fracture", "code_information": [ { "code": "28505", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 19237.5, "discounted_cash": 3868.0, "minimum": 1715.0, "maximum": 15390.0, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 8200.52, "additional_payer_notes": "212.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medical Rental Network", "methodology": "fee schedule", "standard_charge_dollar": 8200.52, "additional_payer_notes": "212.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3868.17, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "ALLY-ALIGN (FKA SPARTAN PLAN NJ, INC.)", "plan_name": "ALLY-ALIGN (FKA SPARTAN PLAN NJ, INC.)", "methodology": "fee schedule", "standard_charge_dollar": 4061.58, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Americhoice (UHC)", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3868.17, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Amerihealth", "plan_name": "Amerihealth Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3868.17, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 5684.28, "additional_payer_notes": "146.95% of Medicare Rates" }, { "payer_name": "Clover Health", "plan_name": "Clover Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3868.17, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Coventry", "plan_name": "Coventry Auto", "methodology": "fee schedule", "standard_charge_dollar": 7736.34, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Coventry", "plan_name": "Coventry Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 7736.34, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "fee schedule", "standard_charge_dollar": 5415.44, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Fairprice Healthcare Holdings", "plan_name": "Fairprice Healthcare Holdings", "methodology": "fee schedule", "standard_charge_dollar": 6189.07, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ HMO POS", "methodology": "fee schedule", "standard_charge_dollar": 6858.27, "additional_payer_notes": "177.30% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ Indemnity", "methodology": "fee schedule", "standard_charge_dollar": 6858.27, "additional_payer_notes": "177.30% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ PPO", "methodology": "fee schedule", "standard_charge_dollar": 6858.27, "additional_payer_notes": "177.30% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3868.17, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon NJ Health Medicaid", "methodology": "percent of total billed charges", "standard_charge_percentage": 19.58, "median_amount": 6778.6, "10th_percentile": 6778.6, "90th_percentile": 6778.6, "count": "1 through 10" }, { "payer_name": "Humana", "plan_name": "Humana Military Tricare", "methodology": "fee schedule", "standard_charge_dollar": 3094.54, "additional_payer_notes": "80.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3868.17, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 3868.17, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC All Payer (02-01-2023 to 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 4415.0 }, { "payer_name": "UHC", "plan_name": "UHC Oxford (02-01-2023 to 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 4020.0 }, { "payer_name": "UHC - Adhoc", "plan_name": "UHC - Adhoc All Payer", "methodology": "case rate", "standard_charge_dollar": 4687.0 }, { "payer_name": "UHC - Adhoc", "plan_name": "UHC - Adhoc Oxford", "methodology": "case rate", "standard_charge_dollar": 4143.0 }, { "payer_name": "Wellcare", "plan_name": "Wellcare Insurance Exchange", "methodology": "fee schedule", "standard_charge_dollar": 5222.03, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3868.17, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellchoice", "plan_name": "WELLCHOICE HMO of NJ (Empire) Commercial (HMO / HMO POS, PPO)", "methodology": "case rate", "standard_charge_dollar": 1715.0 }, { "payer_name": "Wellchoice", "plan_name": "WELLCHOICE HMO of NJ (Empire) Commercial (Indemnity)", "methodology": "case rate", "standard_charge_dollar": 1978.0 }, { "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3868.17, "additional_payer_notes": "100.00% of Medicare Rates" } ] } ] }, { "description": "Hc Occult Blood Other Sources", "code_information": [ { "code": "82271", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 18.89, "discounted_cash": 5.0, "minimum": 3.19, "maximum": 16.0565, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 11.28, "additional_payer_notes": "212.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medical Rental Network", "methodology": "fee schedule", "standard_charge_dollar": 11.28, "additional_payer_notes": "212.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5.32, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "ALLY-ALIGN (FKA SPARTAN PLAN NJ, INC.)", "plan_name": "ALLY-ALIGN (FKA SPARTAN PLAN NJ, INC.)", "methodology": "fee schedule", "standard_charge_dollar": 5.59, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Americhoice (UHC)", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5.32, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Amerihealth", "plan_name": "Amerihealth Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5.32, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 7.71, "additional_payer_notes": "Laboratory - 145.00% of Medicare Rates" }, { "payer_name": "Clover Health", "plan_name": "Clover Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5.32, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Coventry", "plan_name": "Coventry Auto", "methodology": "fee schedule", "standard_charge_dollar": 10.64, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Coventry", "plan_name": "Coventry Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 10.64, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "fee schedule", "standard_charge_dollar": 7.45, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Fairprice Healthcare Holdings", "plan_name": "Fairprice Healthcare Holdings", "methodology": "fee schedule", "standard_charge_dollar": 6.38, "additional_payer_notes": "Laboratory - 120.00% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ HMO POS", "methodology": "fee schedule", "standard_charge_dollar": 13.34, "additional_payer_notes": "177.30% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ Indemnity", "methodology": "fee schedule", "standard_charge_dollar": 13.34, "additional_payer_notes": "177.30% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ PPO", "methodology": "fee schedule", "standard_charge_dollar": 13.34, "additional_payer_notes": "177.30% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5.32, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Military Tricare", "methodology": "fee schedule", "standard_charge_dollar": 4.26, "additional_payer_notes": "80.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5.32, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 5.32, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC All Payer (02-01-2023 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 3.19 }, { "payer_name": "UHC", "plan_name": "UHC Medicaid (02/01/2023 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 4.26 }, { "payer_name": "UHC", "plan_name": "UHC Oxford (02-01-2023 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 3.19 }, { "payer_name": "UHC - Adhoc", "plan_name": "UHC - Adhoc All Payer", "methodology": "fee schedule", "standard_charge_dollar": 5.32 }, { "payer_name": "UHC - Adhoc", "plan_name": "UHC - Adhoc Oxford", "methodology": "fee schedule", "standard_charge_dollar": 5.32 }, { "payer_name": "Wellcare", "plan_name": "Wellcare Insurance Exchange", "methodology": "fee schedule", "standard_charge_dollar": 7.18, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5.32, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5.32, "additional_payer_notes": "100.00% of Medicare Rates" } ] } ] }, { "description": "REPAIR BLOOD VESSEL LESION", "code_information": [ { "code": "35207", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 2608.16, "discounted_cash": 3732.0, "minimum": 497.8977, "maximum": 2608.16, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 2608.16, "additional_payer_notes": "212.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medical Rental Network", "methodology": "fee schedule", "standard_charge_dollar": 2608.16, "additional_payer_notes": "212.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2608.16, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "ALLY-ALIGN (FKA SPARTAN PLAN NJ, INC.)", "plan_name": "ALLY-ALIGN (FKA SPARTAN PLAN NJ, INC.)", "methodology": "fee schedule", "standard_charge_dollar": 2608.16, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Americhoice (UHC)", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2608.16, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Amerihealth", "plan_name": "Amerihealth Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2608.16, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 2608.16, "additional_payer_notes": "146.95% of Medicare Rates" }, { "payer_name": "Clover Health", "plan_name": "Clover Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2608.16, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Coventry", "plan_name": "Coventry Auto", "methodology": "fee schedule", "standard_charge_dollar": 2608.16, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Coventry", "plan_name": "Coventry Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 2608.16, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "fee schedule", "standard_charge_dollar": 2608.16, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Fairprice Healthcare Holdings", "plan_name": "Fairprice Healthcare Holdings", "methodology": "fee schedule", "standard_charge_dollar": 2608.16, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ HMO POS", "methodology": "fee schedule", "standard_charge_dollar": 2608.16, "additional_payer_notes": "177.30% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ Indemnity", "methodology": "fee schedule", "standard_charge_dollar": 2608.16, "additional_payer_notes": "177.30% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ PPO", "methodology": "fee schedule", "standard_charge_dollar": 2608.16, "additional_payer_notes": "177.30% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2608.16, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Military Tricare", "methodology": "fee schedule", "standard_charge_dollar": 2608.16, "additional_payer_notes": "80.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2608.16, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 2608.16, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC All Payer (02-01-2023 to 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 2608.16 }, { "payer_name": "UHC", "plan_name": "UHC Oxford (02-01-2023 to 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 2608.16 }, { "payer_name": "UHC - Adhoc", "plan_name": "UHC - Adhoc All Payer", "methodology": "case rate", "standard_charge_dollar": 2608.16 }, { "payer_name": "UHC - Adhoc", "plan_name": "UHC - Adhoc Oxford", "methodology": "case rate", "standard_charge_dollar": 2608.16 }, { "payer_name": "Wellcare", "plan_name": "Wellcare Insurance Exchange", "methodology": "fee schedule", "standard_charge_dollar": 2608.16, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2608.16, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellchoice", "plan_name": "WELLCHOICE HMO of NJ (Empire) Commercial (HMO / HMO POS, PPO)", "methodology": "case rate", "standard_charge_dollar": 1715.0 }, { "payer_name": "Wellchoice", "plan_name": "WELLCHOICE HMO of NJ (Empire) Commercial (Indemnity)", "methodology": "case rate", "standard_charge_dollar": 1978.0 }, { "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2608.16, "additional_payer_notes": "100.00% of Medicare Rates" } ] } ] }, { "description": "Treat lower leg fracture", "code_information": [ { "code": "27827", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 64920.0, "discounted_cash": 15177.0, "minimum": 1715.0, "maximum": 51936.0, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 32177.25, "additional_payer_notes": "212.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medical Rental Network", "methodology": "fee schedule", "standard_charge_dollar": 32177.25, "additional_payer_notes": "212.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 15177.95, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "ALLY-ALIGN (FKA SPARTAN PLAN NJ, INC.)", "plan_name": "ALLY-ALIGN (FKA SPARTAN PLAN NJ, INC.)", "methodology": "fee schedule", "standard_charge_dollar": 15936.85, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Americhoice (UHC)", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 15177.95, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Amerihealth", "plan_name": "Amerihealth Medicare", "methodology": "fee schedule", "standard_charge_dollar": 15177.95, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 22304.0, "additional_payer_notes": "146.95% of Medicare Rates" }, { "payer_name": "Clover Health", "plan_name": "Clover Medicare", "methodology": "fee schedule", "standard_charge_dollar": 15177.95, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Coventry", "plan_name": "Coventry Auto", "methodology": "fee schedule", "standard_charge_dollar": 30355.9, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Coventry", "plan_name": "Coventry Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 30355.9, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "fee schedule", "standard_charge_dollar": 21249.13, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Fairprice Healthcare Holdings", "plan_name": "Fairprice Healthcare Holdings", "methodology": "fee schedule", "standard_charge_dollar": 24284.72, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ HMO POS", "methodology": "fee schedule", "standard_charge_dollar": 26910.51, "additional_payer_notes": "177.30% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ Indemnity", "methodology": "fee schedule", "standard_charge_dollar": 26910.51, "additional_payer_notes": "177.30% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ PPO", "methodology": "fee schedule", "standard_charge_dollar": 26910.51, "additional_payer_notes": "177.30% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon Medicare", "methodology": "fee schedule", "standard_charge_dollar": 15177.95, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Military Tricare", "methodology": "fee schedule", "standard_charge_dollar": 12142.36, "additional_payer_notes": "80.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 15177.95, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 15177.95, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC All Payer (02-01-2023 to 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 6624.0 }, { "payer_name": "UHC", "plan_name": "UHC Oxford (02-01-2023 to 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 6317.0 }, { "payer_name": "UHC - Adhoc", "plan_name": "UHC - Adhoc All Payer", "methodology": "case rate", "standard_charge_dollar": 7031.0 }, { "payer_name": "UHC - Adhoc", "plan_name": "UHC - Adhoc Oxford", "methodology": "case rate", "standard_charge_dollar": 6510.0 }, { "payer_name": "Wellcare", "plan_name": "Wellcare Insurance Exchange", "methodology": "fee schedule", "standard_charge_dollar": 20490.23, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 15177.95, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellchoice", "plan_name": "WELLCHOICE HMO of NJ (Empire) Commercial (HMO / HMO POS, PPO)", "methodology": "case rate", "standard_charge_dollar": 1715.0 }, { "payer_name": "Wellchoice", "plan_name": "WELLCHOICE HMO of NJ (Empire) Commercial (Indemnity)", "methodology": "case rate", "standard_charge_dollar": 1978.0 }, { "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup Medicare", "methodology": "fee schedule", "standard_charge_dollar": 15177.95, "additional_payer_notes": "100.00% of Medicare Rates" } ] } ] }, { "description": "Hc Cath Plc/Cor Angio Rs/I Bypas Angio W R Ht Cath", "code_information": [ { "code": "93457", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 16158.5, "discounted_cash": 3832.0, "minimum": 2472.0, "maximum": 12926.8, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 8125.18, "additional_payer_notes": "212.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medical Rental Network", "methodology": "fee schedule", "standard_charge_dollar": 8125.18, "additional_payer_notes": "212.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3832.63, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "ALLY-ALIGN (FKA SPARTAN PLAN NJ, INC.)", "plan_name": "ALLY-ALIGN (FKA SPARTAN PLAN NJ, INC.)", "methodology": "fee schedule", "standard_charge_dollar": 4024.26, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Americhoice (UHC)", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3832.63, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Amerihealth", "plan_name": "Amerihealth Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3832.63, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 5632.05, "additional_payer_notes": "146.95% of Medicare Rates" }, { "payer_name": "Clover Health", "plan_name": "Clover Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3832.63, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Coventry", "plan_name": "Coventry Auto", "methodology": "fee schedule", "standard_charge_dollar": 7665.26, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Coventry", "plan_name": "Coventry Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 7665.26, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "fee schedule", "standard_charge_dollar": 5365.68, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Fairprice Healthcare Holdings", "plan_name": "Fairprice Healthcare Holdings", "methodology": "fee schedule", "standard_charge_dollar": 6132.21, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ HMO POS", "methodology": "fee schedule", "standard_charge_dollar": 6795.25, "additional_payer_notes": "177.30% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ Indemnity", "methodology": "fee schedule", "standard_charge_dollar": 6795.25, "additional_payer_notes": "177.30% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ PPO", "methodology": "fee schedule", "standard_charge_dollar": 6795.25, "additional_payer_notes": "177.30% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3832.63, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Military Tricare", "methodology": "fee schedule", "standard_charge_dollar": 3066.1, "additional_payer_notes": "80.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3832.63, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 3832.63, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC All Payer (02-01-2023 to 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 5667.0 }, { "payer_name": "UHC", "plan_name": "UHC Oxford (02-01-2023 to 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 5169.0 }, { "payer_name": "UHC - Adhoc", "plan_name": "UHC - Adhoc All Payer", "methodology": "case rate", "standard_charge_dollar": 6016.0 }, { "payer_name": "UHC - Adhoc", "plan_name": "UHC - Adhoc Oxford", "methodology": "case rate", "standard_charge_dollar": 5327.0 }, { "payer_name": "Wellcare", "plan_name": "Wellcare Insurance Exchange", "methodology": "fee schedule", "standard_charge_dollar": 5174.05, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3832.63, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellchoice", "plan_name": "WELLCHOICE HMO of NJ (Empire) Commercial (HMO / HMO POS, PPO)", "methodology": "case rate", "standard_charge_dollar": 2472.0 }, { "payer_name": "Wellchoice", "plan_name": "WELLCHOICE HMO of NJ (Empire) Commercial (Indemnity)", "methodology": "case rate", "standard_charge_dollar": 2753.0 }, { "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3832.63, "additional_payer_notes": "100.00% of Medicare Rates" } ] } ] }, { "description": "DILATION & CURETTAGE FOR NON-OBSTETRIC DIAGNOSES - SOI : 1", "code_information": [ { "code": "5171", "type": "APR-DRG" } ], "standard_charges": [ { "setting": "inpatient", "minimum": 8840.2, "maximum": 9724.22, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Better Health - Medi Medi", "methodology": "case rate", "standard_charge_dollar": 9724.22, "additional_payer_notes": "110% of State Medicaid Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Better Health Medicaid", "methodology": "case rate", "standard_charge_dollar": 9724.22, "additional_payer_notes": "110% of State Medicaid Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "case rate", "standard_charge_dollar": 8840.2, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "UBH", "plan_name": "UBH Medicaid", "methodology": "case rate", "standard_charge_dollar": 8840.2, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicaid (02/01/2023 to 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 9017.0, "additional_payer_notes": "102% of State Medicaid Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicaid", "methodology": "case rate", "standard_charge_dollar": 8840.2, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup Medicaid", "methodology": "case rate", "standard_charge_dollar": 8840.2, "additional_payer_notes": "100% of State Medicaid Rates" } ] } ] }, { "description": "SEPTIC ARTHRITIS WITHOUT CCMCC", "code_information": [ { "code": "550", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 11658.0, "minimum": 5768.52, "maximum": 21101.3963, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "case rate", "standard_charge_dollar": 21101.4, "additional_payer_notes": "181.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medical Rental Network", "methodology": "case rate", "standard_charge_dollar": 21101.4, "additional_payer_notes": "181.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "case rate", "standard_charge_dollar": 9667.96, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "ALLY-ALIGN (FKA SPARTAN PLAN NJ, INC.)", "plan_name": "ALLY-ALIGN (FKA SPARTAN PLAN NJ, INC.)", "methodology": "case rate", "standard_charge_dollar": 12241.14, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Americhoice (UHC)", "plan_name": "UHC Medicare", "methodology": "case rate", "standard_charge_dollar": 9667.96, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Amerihealth", "plan_name": "Amerihealth Medicare", "methodology": "case rate", "standard_charge_dollar": 9667.96, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Commercial", "methodology": "case rate", "standard_charge_dollar": 12788.08 }, { "payer_name": "Clover Health", "plan_name": "Clover Medicare", "methodology": "case rate", "standard_charge_dollar": 9667.96, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Coventry", "plan_name": "Coventry Auto", "methodology": "case rate", "standard_charge_dollar": 19818.99, "additional_payer_notes": "170.00% of Medicare Rates" }, { "payer_name": "Coventry", "plan_name": "Coventry Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 19818.99, "additional_payer_notes": "170.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "case rate", "standard_charge_dollar": 15155.7, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Fairprice Healthcare Holdings", "plan_name": "Fairprice Healthcare Holdings", "methodology": "case rate", "standard_charge_dollar": 18653.17, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon Medicare", "methodology": "case rate", "standard_charge_dollar": 9667.96, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon NJ Health Medicaid", "methodology": "case rate", "standard_charge_dollar": 5768.52 }, { "payer_name": "Humana", "plan_name": "Humana Military Tricare", "methodology": "case rate", "standard_charge_dollar": 9326.58, "additional_payer_notes": "80.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 11658.23, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 9780.53 }, { "payer_name": "UBH", "plan_name": "UBH Medicare", "methodology": "case rate", "standard_charge_dollar": 9667.96, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC All Payer (02-01-2023 to 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 14733.83 }, { "payer_name": "UHC", "plan_name": "UHC Oxford (02-01-2023 to 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 12840.53 }, { "payer_name": "UHC - Adhoc", "plan_name": "UHC - Adhoc All Payer", "methodology": "case rate", "standard_charge_dollar": 15640.27 }, { "payer_name": "UHC - Adhoc", "plan_name": "UHC - Adhoc Oxford", "methodology": "case rate", "standard_charge_dollar": 13232.13 }, { "payer_name": "Wellcare", "plan_name": "Wellcare Insurance Exchange", "methodology": "case rate", "standard_charge_dollar": 15738.61, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "case rate", "standard_charge_dollar": 9667.96, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup Medicare", "methodology": "case rate", "standard_charge_dollar": 9667.96, "additional_payer_notes": "100.00% of Medicare Rates" } ] } ] }, { "description": "Hc Diab Op Manage Group Per 30 Min", "code_information": [ { "code": "G0109", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 96.0, "discounted_cash": 17.0, "minimum": 14.208, "maximum": 96.0, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 37.65, "additional_payer_notes": "212.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medical Rental Network", "methodology": "fee schedule", "standard_charge_dollar": 37.65, "additional_payer_notes": "212.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 17.76, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "ALLY-ALIGN (FKA SPARTAN PLAN NJ, INC.)", "plan_name": "ALLY-ALIGN (FKA SPARTAN PLAN NJ, INC.)", "methodology": "fee schedule", "standard_charge_dollar": 18.65, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Americhoice (UHC)", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 17.76, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Amerihealth", "plan_name": "Amerihealth Medicare", "methodology": "fee schedule", "standard_charge_dollar": 17.76, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 27.53, "additional_payer_notes": "A Indicator - 155.00% of Medicare Rates" }, { "payer_name": "Clover Health", "plan_name": "Clover Medicare", "methodology": "fee schedule", "standard_charge_dollar": 17.76, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Coventry", "plan_name": "Coventry Auto", "methodology": "fee schedule", "standard_charge_dollar": 35.52, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Coventry", "plan_name": "Coventry Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 35.52, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "fee schedule", "standard_charge_dollar": 24.86, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Fairprice Healthcare Holdings", "plan_name": "Fairprice Healthcare Holdings", "methodology": "fee schedule", "standard_charge_dollar": 28.42 }, { "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ HMO POS", "methodology": "fee schedule", "standard_charge_dollar": 67.78, "additional_payer_notes": "177.30% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ Indemnity", "methodology": "fee schedule", "standard_charge_dollar": 67.78, "additional_payer_notes": "177.30% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ PPO", "methodology": "fee schedule", "standard_charge_dollar": 67.78, "additional_payer_notes": "177.30% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon Medicare", "methodology": "fee schedule", "standard_charge_dollar": 17.76, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Military Tricare", "methodology": "fee schedule", "standard_charge_dollar": 14.21, "additional_payer_notes": "80.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 17.76, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 17.76, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC All Payer (02-01-2023 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 96.0 }, { "payer_name": "UHC", "plan_name": "UHC Oxford (02-01-2023 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 96.0 }, { "payer_name": "UHC - Adhoc", "plan_name": "UHC - Adhoc All Payer", "methodology": "fee schedule", "standard_charge_dollar": 96.0 }, { "payer_name": "UHC - Adhoc", "plan_name": "UHC - Adhoc Oxford", "methodology": "fee schedule", "standard_charge_dollar": 96.0 }, { "payer_name": "Wellcare", "plan_name": "Wellcare Insurance Exchange", "methodology": "fee schedule", "standard_charge_dollar": 23.98, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 17.76, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup Medicare", "methodology": "fee schedule", "standard_charge_dollar": 17.76, "additional_payer_notes": "100.00% of Medicare Rates" } ] } ] }, { "description": "Hc Rbc Antibody Elution", "code_information": [ { "code": "86860", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 723.65, "discounted_cash": 201.0, "minimum": 4.2, "maximum": 615.1025, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 426.99, "additional_payer_notes": "212.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medical Rental Network", "methodology": "fee schedule", "standard_charge_dollar": 426.99, "additional_payer_notes": "212.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 201.41, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "ALLY-ALIGN (FKA SPARTAN PLAN NJ, INC.)", "plan_name": "ALLY-ALIGN (FKA SPARTAN PLAN NJ, INC.)", "methodology": "fee schedule", "standard_charge_dollar": 211.48, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Americhoice (UHC)", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 201.41, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Amerihealth", "plan_name": "Amerihealth Medicare", "methodology": "fee schedule", "standard_charge_dollar": 201.41, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 295.97, "additional_payer_notes": "146.95% of Medicare Rates" }, { "payer_name": "Clover Health", "plan_name": "Clover Medicare", "methodology": "fee schedule", "standard_charge_dollar": 201.41, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Coventry", "plan_name": "Coventry Auto", "methodology": "fee schedule", "standard_charge_dollar": 402.82, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Coventry", "plan_name": "Coventry Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 402.82, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "fee schedule", "standard_charge_dollar": 281.97, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Fairprice Healthcare Holdings", "plan_name": "Fairprice Healthcare Holdings", "methodology": "fee schedule", "standard_charge_dollar": 322.26, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ HMO POS", "methodology": "fee schedule", "standard_charge_dollar": 357.1, "additional_payer_notes": "177.30% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ Indemnity", "methodology": "fee schedule", "standard_charge_dollar": 357.1, "additional_payer_notes": "177.30% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ PPO", "methodology": "fee schedule", "standard_charge_dollar": 357.1, "additional_payer_notes": "177.30% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon Medicare", "methodology": "fee schedule", "standard_charge_dollar": 201.41, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Military Tricare", "methodology": "fee schedule", "standard_charge_dollar": 161.13, "additional_payer_notes": "80.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 201.41, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 201.41, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC All Payer (02-01-2023 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 86.1 }, { "payer_name": "UHC", "plan_name": "UHC Medicaid (02/01/2023 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 4.2 }, { "payer_name": "UHC", "plan_name": "UHC Oxford (02-01-2023 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 86.1 }, { "payer_name": "UHC - Adhoc", "plan_name": "UHC - Adhoc All Payer", "methodology": "fee schedule", "standard_charge_dollar": 143.5 }, { "payer_name": "UHC - Adhoc", "plan_name": "UHC - Adhoc Oxford", "methodology": "fee schedule", "standard_charge_dollar": 143.5 }, { "payer_name": "Wellcare", "plan_name": "Wellcare Insurance Exchange", "methodology": "fee schedule", "standard_charge_dollar": 271.9, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 201.41, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup Medicare", "methodology": "fee schedule", "standard_charge_dollar": 201.41, "additional_payer_notes": "100.00% of Medicare Rates" } ] } ] }, { "description": "DILATION & CURETTAGE FOR NON-OBSTETRIC DIAGNOSES - SOI : 3", "code_information": [ { "code": "5173", "type": "APR-DRG" } ], "standard_charges": [ { "setting": "inpatient", "minimum": 17624.94, "maximum": 19387.43, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Better Health - Medi Medi", "methodology": "case rate", "standard_charge_dollar": 19387.43, "additional_payer_notes": "110% of State Medicaid Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Better Health Medicaid", "methodology": "case rate", "standard_charge_dollar": 19387.43, "additional_payer_notes": "110% of State Medicaid Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "case rate", "standard_charge_dollar": 17624.94, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "UBH", "plan_name": "UBH Medicaid", "methodology": "case rate", "standard_charge_dollar": 17624.94, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicaid (02/01/2023 to 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 17977.44, "additional_payer_notes": "102% of State Medicaid Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicaid", "methodology": "case rate", "standard_charge_dollar": 17624.94, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup Medicaid", "methodology": "case rate", "standard_charge_dollar": 17624.94, "additional_payer_notes": "100% of State Medicaid Rates" } ] } ] }, { "description": "Hc Sclerotherapy Fluid Collection Prq W/ Img Gdn", "code_information": [ { "code": "49185", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 2896.7, "discounted_cash": 1952.0, "minimum": 552.98, "maximum": 2896.7, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 2896.7, "additional_payer_notes": "212.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medical Rental Network", "methodology": "fee schedule", "standard_charge_dollar": 2896.7, "additional_payer_notes": "212.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1952.53, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "ALLY-ALIGN (FKA SPARTAN PLAN NJ, INC.)", "plan_name": "ALLY-ALIGN (FKA SPARTAN PLAN NJ, INC.)", "methodology": "fee schedule", "standard_charge_dollar": 2050.16, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Americhoice (UHC)", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1952.53, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Amerihealth", "plan_name": "Amerihealth Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1952.53, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 2869.24, "additional_payer_notes": "146.95% of Medicare Rates" }, { "payer_name": "Clover Health", "plan_name": "Clover Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1952.53, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Coventry", "plan_name": "Coventry Auto", "methodology": "fee schedule", "standard_charge_dollar": 2896.7, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Coventry", "plan_name": "Coventry Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 2896.7, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "fee schedule", "standard_charge_dollar": 2733.54, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Fairprice Healthcare Holdings", "plan_name": "Fairprice Healthcare Holdings", "methodology": "fee schedule", "standard_charge_dollar": 2896.7, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ HMO POS", "methodology": "fee schedule", "standard_charge_dollar": 2896.7, "additional_payer_notes": "177.30% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ Indemnity", "methodology": "fee schedule", "standard_charge_dollar": 2896.7, "additional_payer_notes": "177.30% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ PPO", "methodology": "fee schedule", "standard_charge_dollar": 2896.7, "additional_payer_notes": "177.30% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1952.53, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Military Tricare", "methodology": "fee schedule", "standard_charge_dollar": 1562.02, "additional_payer_notes": "80.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1952.53, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 1952.53, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC All Payer (02-01-2023 to 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 2896.7 }, { "payer_name": "UHC", "plan_name": "UHC Oxford (02-01-2023 to 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 2297.0 }, { "payer_name": "UHC - Adhoc", "plan_name": "UHC - Adhoc All Payer", "methodology": "case rate", "standard_charge_dollar": 2896.7 }, { "payer_name": "UHC - Adhoc", "plan_name": "UHC - Adhoc Oxford", "methodology": "case rate", "standard_charge_dollar": 2367.0 }, { "payer_name": "Wellcare", "plan_name": "Wellcare Insurance Exchange", "methodology": "fee schedule", "standard_charge_dollar": 2635.92, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1952.53, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1952.53, "additional_payer_notes": "100.00% of Medicare Rates" } ] } ] }, { "description": "NEONATE BWT 1500-2499G W MAJOR PROCEDURE - SOI : 2", "code_information": [ { "code": "6092", "type": "APR-DRG" } ], "standard_charges": [ { "setting": "inpatient", "minimum": 52277.87, "maximum": 57505.66, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Better Health - Medi Medi", "methodology": "case rate", "standard_charge_dollar": 57505.66, "additional_payer_notes": "110% of State Medicaid Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Better Health Medicaid", "methodology": "case rate", "standard_charge_dollar": 57505.66, "additional_payer_notes": "110% of State Medicaid Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "case rate", "standard_charge_dollar": 52277.87, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "UBH", "plan_name": "UBH Medicaid", "methodology": "case rate", "standard_charge_dollar": 52277.87, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicaid (02/01/2023 to 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 53323.43, "additional_payer_notes": "102% of State Medicaid Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicaid", "methodology": "case rate", "standard_charge_dollar": 52277.87, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup Medicaid", "methodology": "case rate", "standard_charge_dollar": 52277.87, "additional_payer_notes": "100% of State Medicaid Rates" } ] } ] }, { "description": "Hc Evasc Rpr Dplmnt Aorto-Aortic Ndgft", "code_information": [ { "code": "34701", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 14858.8, "minimum": 1301.71, "maximum": 11887.04, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1301.71, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC All Payer (02-01-2023 to 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 4889.0 }, { "payer_name": "UHC", "plan_name": "UHC Oxford (02-01-2023 to 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 4020.0 }, { "payer_name": "UHC - Adhoc", "plan_name": "UHC - Adhoc All Payer", "methodology": "case rate", "standard_charge_dollar": 5190.0 }, { "payer_name": "UHC - Adhoc", "plan_name": "UHC - Adhoc Oxford", "methodology": "case rate", "standard_charge_dollar": 4143.0 }, { "payer_name": "Wellchoice", "plan_name": "WELLCHOICE HMO of NJ (Empire) Commercial (HMO / HMO POS, PPO)", "methodology": "case rate", "standard_charge_dollar": 2472.0 }, { "payer_name": "Wellchoice", "plan_name": "WELLCHOICE HMO of NJ (Empire) Commercial (Indemnity)", "methodology": "case rate", "standard_charge_dollar": 2753.0 } ] } ] }, { "description": "Hc Mri, Cerv Spine Combo", "code_information": [ { "code": "72156", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 5544.52, "discounted_cash": 412.0, "minimum": 329.952, "maximum": 4712.842, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 874.37, "additional_payer_notes": "212.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medical Rental Network", "methodology": "fee schedule", "standard_charge_dollar": 874.37, "additional_payer_notes": "212.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 412.44, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "ALLY-ALIGN (FKA SPARTAN PLAN NJ, INC.)", "plan_name": "ALLY-ALIGN (FKA SPARTAN PLAN NJ, INC.)", "methodology": "fee schedule", "standard_charge_dollar": 433.06, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Americhoice (UHC)", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 412.44, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Amerihealth", "plan_name": "Amerihealth HMO", "methodology": "fee schedule", "standard_charge_dollar": 1241.24 }, { "payer_name": "Amerihealth", "plan_name": "Amerihealth Medicare", "methodology": "fee schedule", "standard_charge_dollar": 412.44, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 606.08, "additional_payer_notes": "146.95% of Medicare Rates" }, { "payer_name": "Clover Health", "plan_name": "Clover Medicare", "methodology": "fee schedule", "standard_charge_dollar": 412.44, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Coventry", "plan_name": "Coventry Auto", "methodology": "fee schedule", "standard_charge_dollar": 824.88, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Coventry", "plan_name": "Coventry Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 824.88, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "fee schedule", "standard_charge_dollar": 577.42, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Fairprice Healthcare Holdings", "plan_name": "Fairprice Healthcare Holdings", "methodology": "fee schedule", "standard_charge_dollar": 659.9, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ HMO POS", "methodology": "fee schedule", "standard_charge_dollar": 731.26, "additional_payer_notes": "177.30% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ Indemnity", "methodology": "fee schedule", "standard_charge_dollar": 731.26, "additional_payer_notes": "177.30% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ PPO", "methodology": "fee schedule", "standard_charge_dollar": 731.26, "additional_payer_notes": "177.30% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon Medicare", "methodology": "fee schedule", "standard_charge_dollar": 412.44, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Military Tricare", "methodology": "fee schedule", "standard_charge_dollar": 329.95, "additional_payer_notes": "80.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 412.44, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 412.44, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC All Payer (02-01-2023 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 552.18 }, { "payer_name": "UHC", "plan_name": "UHC Medicaid (02/01/2023 to 12-31-2026)", "methodology": "percent of total billed charges", "standard_charge_percentage": 19.47, "median_amount": 1079.62, "10th_percentile": 1079.62, "90th_percentile": 1079.62, "count": "1 through 10" }, { "payer_name": "UHC", "plan_name": "UHC Oxford (02-01-2023 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 552.18 }, { "payer_name": "UHC - Adhoc", "plan_name": "UHC - Adhoc All Payer", "methodology": "fee schedule", "standard_charge_dollar": 368.12 }, { "payer_name": "UHC - Adhoc", "plan_name": "UHC - Adhoc Oxford", "methodology": "fee schedule", "standard_charge_dollar": 368.12 }, { "payer_name": "Wellcare", "plan_name": "Wellcare Insurance Exchange", "methodology": "fee schedule", "standard_charge_dollar": 556.79, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 412.44, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup Medicare", "methodology": "fee schedule", "standard_charge_dollar": 412.44, "additional_payer_notes": "100.00% of Medicare Rates" } ] } ] }, { "description": "OTHER KIDNEY, URINARY TRACT & RELATED PROCEDURES - SOI : 4", "code_information": [ { "code": "4474", "type": "APR-DRG" } ], "standard_charges": [ { "setting": "inpatient", "minimum": 51709.46, "maximum": 56880.41, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Better Health - Medi Medi", "methodology": "case rate", "standard_charge_dollar": 56880.41, "additional_payer_notes": "110% of State Medicaid Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Better Health Medicaid", "methodology": "case rate", "standard_charge_dollar": 56880.41, "additional_payer_notes": "110% of State Medicaid Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "case rate", "standard_charge_dollar": 51709.46, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "UBH", "plan_name": "UBH Medicaid", "methodology": "case rate", "standard_charge_dollar": 51709.46, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicaid (02/01/2023 to 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 52743.65, "additional_payer_notes": "102% of State Medicaid Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicaid", "methodology": "case rate", "standard_charge_dollar": 51709.46, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup Medicaid", "methodology": "case rate", "standard_charge_dollar": 51709.46, "additional_payer_notes": "100% of State Medicaid Rates" } ] } ] }, { "description": "DENTAL DISEASES AND DISORDERS - SOI : 3", "code_information": [ { "code": "1143", "type": "APR-DRG" } ], "standard_charges": [ { "setting": "inpatient", "minimum": 10117.6, "maximum": 11129.36, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Better Health - Medi Medi", "methodology": "case rate", "standard_charge_dollar": 11129.36, "additional_payer_notes": "110% of State Medicaid Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Better Health Medicaid", "methodology": "case rate", "standard_charge_dollar": 11129.36, "additional_payer_notes": "110% of State Medicaid Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "case rate", "standard_charge_dollar": 10117.6, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "UBH", "plan_name": "UBH Medicaid", "methodology": "case rate", "standard_charge_dollar": 10117.6, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicaid (02/01/2023 to 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 10319.95, "additional_payer_notes": "102% of State Medicaid Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicaid", "methodology": "case rate", "standard_charge_dollar": 10117.6, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup Medicaid", "methodology": "case rate", "standard_charge_dollar": 10117.6, "additional_payer_notes": "100% of State Medicaid Rates" } ] } ] }, { "description": "SKIN GRAFT EXCEPT FOR SKIN ULCER OR CELLULITIS WITH CC", "code_information": [ { "code": "577", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 32189.0, "minimum": 15668.28, "maximum": 65034.8, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "case rate", "standard_charge_dollar": 58262.92, "additional_payer_notes": "181.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medical Rental Network", "methodology": "case rate", "standard_charge_dollar": 58262.92, "additional_payer_notes": "181.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "case rate", "standard_charge_dollar": 26154.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "ALLY-ALIGN (FKA SPARTAN PLAN NJ, INC.)", "plan_name": "ALLY-ALIGN (FKA SPARTAN PLAN NJ, INC.)", "methodology": "case rate", "standard_charge_dollar": 33798.93, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Americhoice (UHC)", "plan_name": "UHC Medicare", "methodology": "case rate", "standard_charge_dollar": 26154.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Amerihealth", "plan_name": "Amerihealth Medicare", "methodology": "case rate", "standard_charge_dollar": 26154.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Commercial", "methodology": "case rate", "standard_charge_dollar": 38779.74 }, { "payer_name": "Clover Health", "plan_name": "Clover Medicare", "methodology": "case rate", "standard_charge_dollar": 26154.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Coventry", "plan_name": "Coventry Auto", "methodology": "case rate", "standard_charge_dollar": 54722.08, "additional_payer_notes": "170.00% of Medicare Rates" }, { "payer_name": "Coventry", "plan_name": "Coventry Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 54722.08, "additional_payer_notes": "170.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "case rate", "standard_charge_dollar": 41846.3, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Fairprice Healthcare Holdings", "plan_name": "Fairprice Healthcare Holdings", "methodology": "case rate", "standard_charge_dollar": 51503.14, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon Medicare", "methodology": "case rate", "standard_charge_dollar": 26154.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon NJ Health Medicaid", "methodology": "case rate", "standard_charge_dollar": 15668.28 }, { "payer_name": "Humana", "plan_name": "Humana Military Tricare", "methodology": "case rate", "standard_charge_dollar": 25751.57, "additional_payer_notes": "80.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 32189.46, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 65034.8 }, { "payer_name": "UBH", "plan_name": "UBH Medicare", "methodology": "case rate", "standard_charge_dollar": 26154.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC All Payer (02-01-2023 to 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 44680.2 }, { "payer_name": "UHC", "plan_name": "UHC Oxford (02-01-2023 to 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 38938.78 }, { "payer_name": "UHC - Adhoc", "plan_name": "UHC - Adhoc All Payer", "methodology": "case rate", "standard_charge_dollar": 47428.98 }, { "payer_name": "UHC - Adhoc", "plan_name": "UHC - Adhoc Oxford", "methodology": "case rate", "standard_charge_dollar": 40126.3 }, { "payer_name": "Wellcare", "plan_name": "Wellcare Insurance Exchange", "methodology": "case rate", "standard_charge_dollar": 43455.77, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "case rate", "standard_charge_dollar": 26154.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup Medicare", "methodology": "case rate", "standard_charge_dollar": 26154.0, "additional_payer_notes": "100.00% of Medicare Rates" } ] } ] }, { "description": "Hc Prq Drug Eluting Cor Revasc Chro Sin - C9607 - 48100199", "code_information": [ { "code": "C9607", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 48345.2, "discounted_cash": 21671.0, "minimum": 2472.0, "maximum": 45944.11, "payers_information": [ { "payer_name": "Wellcare", "plan_name": "Wellcare Insurance Exchange", "methodology": "fee schedule", "standard_charge_dollar": 29256.86, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 21671.75, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellchoice", "plan_name": "WELLCHOICE HMO of NJ (Empire) Commercial (HMO / HMO POS, PPO)", "methodology": "case rate", "standard_charge_dollar": 2472.0 }, { "payer_name": "Wellchoice", "plan_name": "WELLCHOICE HMO of NJ (Empire) Commercial (Indemnity)", "methodology": "case rate", "standard_charge_dollar": 2753.0 }, { "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup Medicare", "methodology": "fee schedule", "standard_charge_dollar": 21671.75, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 45944.11, "additional_payer_notes": "212.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medical Rental Network", "methodology": "fee schedule", "standard_charge_dollar": 45944.11, "additional_payer_notes": "212.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 21671.75, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "ALLY-ALIGN (FKA SPARTAN PLAN NJ, INC.)", "plan_name": "ALLY-ALIGN (FKA SPARTAN PLAN NJ, INC.)", "methodology": "fee schedule", "standard_charge_dollar": 22755.34, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Americhoice (UHC)", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 21671.75, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Amerihealth", "plan_name": "Amerihealth Medicare", "methodology": "fee schedule", "standard_charge_dollar": 21671.75, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 31846.64, "additional_payer_notes": "146.95% of Medicare Rates" }, { "payer_name": "Clover Health", "plan_name": "Clover Medicare", "methodology": "fee schedule", "standard_charge_dollar": 21671.75, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Coventry", "plan_name": "Coventry Auto", "methodology": "fee schedule", "standard_charge_dollar": 43343.5, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Coventry", "plan_name": "Coventry Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 43343.5, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "fee schedule", "standard_charge_dollar": 30340.45, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Fairprice Healthcare Holdings", "plan_name": "Fairprice Healthcare Holdings", "methodology": "fee schedule", "standard_charge_dollar": 34674.8, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ HMO POS", "methodology": "fee schedule", "standard_charge_dollar": 38424.01, "additional_payer_notes": "177.30% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ Indemnity", "methodology": "fee schedule", "standard_charge_dollar": 38424.01, "additional_payer_notes": "177.30% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ PPO", "methodology": "fee schedule", "standard_charge_dollar": 38424.01, "additional_payer_notes": "177.30% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon Medicare", "methodology": "fee schedule", "standard_charge_dollar": 21671.75, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Military Tricare", "methodology": "fee schedule", "standard_charge_dollar": 17337.4, "additional_payer_notes": "80.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 21671.75, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 21671.75, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC All Payer (02-01-2023 to 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 7566.0 }, { "payer_name": "UHC", "plan_name": "UHC Oxford (02-01-2023 to 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 6317.0 }, { "payer_name": "UHC - Adhoc", "plan_name": "UHC - Adhoc All Payer", "methodology": "case rate", "standard_charge_dollar": 8031.0 }, { "payer_name": "UHC - Adhoc", "plan_name": "UHC - Adhoc Oxford", "methodology": "case rate", "standard_charge_dollar": 6510.0 } ] } ] }, { "description": "Hc Mra Abdomen Wo Contrast - 74185 - 61800002", "code_information": [ { "code": "74185", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 3833.75, "minimum": 299.03, "maximum": 4028.541, "payers_information": [ { "payer_name": "Amerihealth", "plan_name": "Amerihealth HMO", "methodology": "fee schedule", "standard_charge_dollar": 886.6 }, { "payer_name": "UHC", "plan_name": "UHC All Payer (02-01-2023 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 448.55 }, { "payer_name": "UHC", "plan_name": "UHC Oxford (02-01-2023 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 448.55 }, { "payer_name": "UHC - Adhoc", "plan_name": "UHC - Adhoc All Payer", "methodology": "fee schedule", "standard_charge_dollar": 299.03 }, { "payer_name": "UHC - Adhoc", "plan_name": "UHC - Adhoc Oxford", "methodology": "fee schedule", "standard_charge_dollar": 299.03 } ] } ] }, { "description": "Lap Rmvl Gastr Adj All Parts", "code_information": [ { "code": "43774", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 22991.3, "discounted_cash": 4557.0, "minimum": 1715.0, "maximum": 22057.0, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 9662.88, "additional_payer_notes": "212.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medical Rental Network", "methodology": "fee schedule", "standard_charge_dollar": 9662.88, "additional_payer_notes": "212.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 4557.96, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "ALLY-ALIGN (FKA SPARTAN PLAN NJ, INC.)", "plan_name": "ALLY-ALIGN (FKA SPARTAN PLAN NJ, INC.)", "methodology": "fee schedule", "standard_charge_dollar": 4785.86, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Americhoice (UHC)", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 4557.96, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Amerihealth", "plan_name": "Amerihealth Medicare", "methodology": "fee schedule", "standard_charge_dollar": 4557.96, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 6697.92, "additional_payer_notes": "146.95% of Medicare Rates" }, { "payer_name": "Clover Health", "plan_name": "Clover Medicare", "methodology": "fee schedule", "standard_charge_dollar": 4557.96, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Coventry", "plan_name": "Coventry Auto", "methodology": "fee schedule", "standard_charge_dollar": 9115.92, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Coventry", "plan_name": "Coventry Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 9115.92, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "fee schedule", "standard_charge_dollar": 6381.14, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Fairprice Healthcare Holdings", "plan_name": "Fairprice Healthcare Holdings", "methodology": "fee schedule", "standard_charge_dollar": 7292.74, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ HMO POS", "methodology": "fee schedule", "standard_charge_dollar": 8081.26, "additional_payer_notes": "177.30% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ Indemnity", "methodology": "fee schedule", "standard_charge_dollar": 8081.26, "additional_payer_notes": "177.30% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ PPO", "methodology": "fee schedule", "standard_charge_dollar": 8081.26, "additional_payer_notes": "177.30% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon Medicare", "methodology": "fee schedule", "standard_charge_dollar": 4557.96, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Military Tricare", "methodology": "fee schedule", "standard_charge_dollar": 3646.37, "additional_payer_notes": "80.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 4557.96, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 4557.96, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC All Payer (02-01-2023 to 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 20779.0 }, { "payer_name": "UHC", "plan_name": "UHC Oxford (02-01-2023 to 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 19524.0 }, { "payer_name": "UHC - Adhoc", "plan_name": "UHC - Adhoc All Payer", "methodology": "case rate", "standard_charge_dollar": 22057.0 }, { "payer_name": "UHC - Adhoc", "plan_name": "UHC - Adhoc Oxford", "methodology": "case rate", "standard_charge_dollar": 20119.0 }, { "payer_name": "Wellcare", "plan_name": "Wellcare Insurance Exchange", "methodology": "fee schedule", "standard_charge_dollar": 6153.25, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 4557.96, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellchoice", "plan_name": "WELLCHOICE HMO of NJ (Empire) Commercial (HMO / HMO POS, PPO)", "methodology": "case rate", "standard_charge_dollar": 1715.0 }, { "payer_name": "Wellchoice", "plan_name": "WELLCHOICE HMO of NJ (Empire) Commercial (Indemnity)", "methodology": "case rate", "standard_charge_dollar": 1978.0 }, { "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup Medicare", "methodology": "fee schedule", "standard_charge_dollar": 4557.96, "additional_payer_notes": "100.00% of Medicare Rates" } ] } ] }, { "description": "TONSIL & ADENOID PROCEDURES - SOI : 4", "code_information": [ { "code": "0974", "type": "APR-DRG" } ], "standard_charges": [ { "setting": "inpatient", "minimum": 30101.44, "maximum": 33111.59, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Better Health - Medi Medi", "methodology": "case rate", "standard_charge_dollar": 33111.59, "additional_payer_notes": "110% of State Medicaid Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Better Health Medicaid", "methodology": "case rate", "standard_charge_dollar": 33111.59, "additional_payer_notes": "110% of State Medicaid Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "case rate", "standard_charge_dollar": 30101.44, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "UBH", "plan_name": "UBH Medicaid", "methodology": "case rate", "standard_charge_dollar": 30101.44, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicaid (02/01/2023 to 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 30703.47, "additional_payer_notes": "102% of State Medicaid Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicaid", "methodology": "case rate", "standard_charge_dollar": 30101.44, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup Medicaid", "methodology": "case rate", "standard_charge_dollar": 30101.44, "additional_payer_notes": "100% of State Medicaid Rates" } ] } ] }, { "description": "Hc Asser Com Tx Face-Face/15Min", "code_information": [ { "code": "H0039", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 55.48, "minimum": 2.6497, "maximum": 55.48, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 32.75, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon NJ Health Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 55.48 }, { "payer_name": "UBH", "plan_name": "UBH Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 55.48 }, { "payer_name": "UHC", "plan_name": "UHC Medicaid (02/01/2023 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 55.48 }, { "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup Medicaid", "methodology": "percent of total billed charges", "standard_charge_percentage": 19.09, "median_amount": 388.36, "10th_percentile": 110.96, "90th_percentile": 554.8, "count": "21" } ] } ] }, { "description": "Hc Complex Drainage, Wound", "code_information": [ { "code": "10180", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 11665.2, "discounted_cash": 3433.0, "minimum": 1715.0, "maximum": 9332.16, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 7280.0, "additional_payer_notes": "212.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medical Rental Network", "methodology": "fee schedule", "standard_charge_dollar": 7280.0, "additional_payer_notes": "212.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3433.96, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "ALLY-ALIGN (FKA SPARTAN PLAN NJ, INC.)", "plan_name": "ALLY-ALIGN (FKA SPARTAN PLAN NJ, INC.)", "methodology": "fee schedule", "standard_charge_dollar": 3605.66, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Americhoice (UHC)", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3433.96, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Amerihealth", "plan_name": "Amerihealth Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3433.96, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 5046.2, "additional_payer_notes": "146.95% of Medicare Rates" }, { "payer_name": "Clover Health", "plan_name": "Clover Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3433.96, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Coventry", "plan_name": "Coventry Auto", "methodology": "fee schedule", "standard_charge_dollar": 6867.92, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Coventry", "plan_name": "Coventry Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 6867.92, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "fee schedule", "standard_charge_dollar": 4807.54, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Fairprice Healthcare Holdings", "plan_name": "Fairprice Healthcare Holdings", "methodology": "fee schedule", "standard_charge_dollar": 5494.34, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ HMO POS", "methodology": "fee schedule", "standard_charge_dollar": 6088.41, "additional_payer_notes": "177.30% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ Indemnity", "methodology": "fee schedule", "standard_charge_dollar": 6088.41, "additional_payer_notes": "177.30% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ PPO", "methodology": "fee schedule", "standard_charge_dollar": 6088.41, "additional_payer_notes": "177.30% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3433.96, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Military Tricare", "methodology": "fee schedule", "standard_charge_dollar": 2747.17, "additional_payer_notes": "80.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3433.96, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 3433.96, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC All Payer (02-01-2023 to 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 4415.0 }, { "payer_name": "UHC", "plan_name": "UHC Oxford (02-01-2023 to 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 4020.0 }, { "payer_name": "UHC - Adhoc", "plan_name": "UHC - Adhoc All Payer", "methodology": "case rate", "standard_charge_dollar": 4687.0 }, { "payer_name": "UHC - Adhoc", "plan_name": "UHC - Adhoc Oxford", "methodology": "case rate", "standard_charge_dollar": 4143.0 }, { "payer_name": "Wellcare", "plan_name": "Wellcare Insurance Exchange", "methodology": "fee schedule", "standard_charge_dollar": 4635.85, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3433.96, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellchoice", "plan_name": "WELLCHOICE HMO of NJ (Empire) Commercial (HMO / HMO POS, PPO)", "methodology": "case rate", "standard_charge_dollar": 1715.0 }, { "payer_name": "Wellchoice", "plan_name": "WELLCHOICE HMO of NJ (Empire) Commercial (Indemnity)", "methodology": "case rate", "standard_charge_dollar": 1978.0 }, { "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3433.96, "additional_payer_notes": "100.00% of Medicare Rates" } ] } ] }, { "description": "Hc Chemother, Iv Infusion, Ea Add Hr", "code_information": [ { "code": "96415", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 927.0, "discounted_cash": 85.0, "minimum": 68.088, "maximum": 927.0, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 180.43, "additional_payer_notes": "212.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medical Rental Network", "methodology": "fee schedule", "standard_charge_dollar": 180.43, "additional_payer_notes": "212.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 85.11, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "ALLY-ALIGN (FKA SPARTAN PLAN NJ, INC.)", "plan_name": "ALLY-ALIGN (FKA SPARTAN PLAN NJ, INC.)", "methodology": "fee schedule", "standard_charge_dollar": 89.37, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Americhoice (UHC)", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 85.11, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Amerihealth", "plan_name": "Amerihealth Medicare", "methodology": "fee schedule", "standard_charge_dollar": 85.11, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 125.07, "additional_payer_notes": "146.95% of Medicare Rates" }, { "payer_name": "Clover Health", "plan_name": "Clover Medicare", "methodology": "fee schedule", "standard_charge_dollar": 85.11, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Coventry", "plan_name": "Coventry Auto", "methodology": "fee schedule", "standard_charge_dollar": 170.22, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Coventry", "plan_name": "Coventry Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 170.22, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "fee schedule", "standard_charge_dollar": 119.15, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Fairprice Healthcare Holdings", "plan_name": "Fairprice Healthcare Holdings", "methodology": "fee schedule", "standard_charge_dollar": 136.18, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ HMO POS", "methodology": "fee schedule", "standard_charge_dollar": 150.9, "additional_payer_notes": "177.30% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ Indemnity", "methodology": "fee schedule", "standard_charge_dollar": 150.9, "additional_payer_notes": "177.30% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ PPO", "methodology": "fee schedule", "standard_charge_dollar": 150.9, "additional_payer_notes": "177.30% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon Medicare", "methodology": "fee schedule", "standard_charge_dollar": 85.11, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon NJ Health Medicaid", "methodology": "percent of total billed charges", "standard_charge_percentage": 19.58, "median_amount": 181.51, "10th_percentile": 181.51, "90th_percentile": 363.01, "count": "1 through 10" }, { "payer_name": "Humana", "plan_name": "Humana Military Tricare", "methodology": "fee schedule", "standard_charge_dollar": 68.09, "additional_payer_notes": "80.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 85.11, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 85.11, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC All Payer (02-01-2023 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 927.0 }, { "payer_name": "UHC", "plan_name": "UHC Oxford (02-01-2023 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 927.0 }, { "payer_name": "UHC - Adhoc", "plan_name": "UHC - Adhoc All Payer", "methodology": "fee schedule", "standard_charge_dollar": 927.0 }, { "payer_name": "UHC - Adhoc", "plan_name": "UHC - Adhoc Oxford", "methodology": "fee schedule", "standard_charge_dollar": 927.0 }, { "payer_name": "Wellcare", "plan_name": "Wellcare Insurance Exchange", "methodology": "fee schedule", "standard_charge_dollar": 114.9, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 85.11, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellchoice", "plan_name": "WELLCHOICE HMO of NJ (Empire) Commercial (HMO / HMO POS, PPO)", "methodology": "case rate", "standard_charge_dollar": 167.0 }, { "payer_name": "Wellchoice", "plan_name": "WELLCHOICE HMO of NJ (Empire) Commercial (Indemnity)", "methodology": "case rate", "standard_charge_dollar": 202.0 }, { "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup Medicare", "methodology": "fee schedule", "standard_charge_dollar": 85.11, "additional_payer_notes": "100.00% of Medicare Rates" } ] } ] }, { "description": "HYPERTENSION - SOI : 2", "code_information": [ { "code": "1992", "type": "APR-DRG" } ], "standard_charges": [ { "setting": "inpatient", "minimum": 7734.18, "maximum": 8507.6, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Better Health - Medi Medi", "methodology": "case rate", "standard_charge_dollar": 8507.6, "additional_payer_notes": "110% of State Medicaid Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Better Health Medicaid", "methodology": "case rate", "standard_charge_dollar": 8507.6, "additional_payer_notes": "110% of State Medicaid Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "case rate", "standard_charge_dollar": 7734.18, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "UBH", "plan_name": "UBH Medicaid", "methodology": "case rate", "standard_charge_dollar": 7734.18, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicaid (02/01/2023 to 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 7888.86, "additional_payer_notes": "102% of State Medicaid Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicaid", "methodology": "case rate", "standard_charge_dollar": 7734.18, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup Medicaid", "methodology": "case rate", "standard_charge_dollar": 7734.18, "additional_payer_notes": "100% of State Medicaid Rates" } ] } ] }, { "description": "Hc Alkaloids Not Otherwise Specified - G0480 - 30080323", "code_information": [ { "code": "G0480", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 61.0, "discounted_cash": 114.0, "minimum": 8.3996, "maximum": 754.8, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 61.0, "additional_payer_notes": "212.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medical Rental Network", "methodology": "fee schedule", "standard_charge_dollar": 61.0, "additional_payer_notes": "212.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 61.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "ALLY-ALIGN (FKA SPARTAN PLAN NJ, INC.)", "plan_name": "ALLY-ALIGN (FKA SPARTAN PLAN NJ, INC.)", "methodology": "fee schedule", "standard_charge_dollar": 61.0, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Americhoice (UHC)", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 61.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Amerihealth", "plan_name": "Amerihealth Medicare", "methodology": "fee schedule", "standard_charge_dollar": 61.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 61.0, "additional_payer_notes": "Laboratory - 145.00% of Medicare Rates" }, { "payer_name": "Clover Health", "plan_name": "Clover Medicare", "methodology": "fee schedule", "standard_charge_dollar": 61.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Coventry", "plan_name": "Coventry Auto", "methodology": "fee schedule", "standard_charge_dollar": 61.0, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Coventry", "plan_name": "Coventry Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 61.0, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "fee schedule", "standard_charge_dollar": 61.0, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Fairprice Healthcare Holdings", "plan_name": "Fairprice Healthcare Holdings", "methodology": "fee schedule", "standard_charge_dollar": 61.0, "additional_payer_notes": "Laboratory - 120.00% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ HMO POS", "methodology": "fee schedule", "standard_charge_dollar": 43.07, "additional_payer_notes": "177.30% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ Indemnity", "methodology": "fee schedule", "standard_charge_dollar": 43.07, "additional_payer_notes": "177.30% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ PPO", "methodology": "fee schedule", "standard_charge_dollar": 43.07, "additional_payer_notes": "177.30% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon Medicare", "methodology": "fee schedule", "standard_charge_dollar": 61.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Military Tricare", "methodology": "fee schedule", "standard_charge_dollar": 61.0, "additional_payer_notes": "80.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 61.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 61.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC All Payer (02-01-2023 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 61.0 }, { "payer_name": "UHC", "plan_name": "UHC Medicaid (02/01/2023 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 61.0 }, { "payer_name": "UHC", "plan_name": "UHC Oxford (02-01-2023 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 61.0 }, { "payer_name": "UHC - Adhoc", "plan_name": "UHC - Adhoc All Payer", "methodology": "fee schedule", "standard_charge_dollar": 61.0 }, { "payer_name": "UHC - Adhoc", "plan_name": "UHC - Adhoc Oxford", "methodology": "fee schedule", "standard_charge_dollar": 61.0 }, { "payer_name": "Wellcare", "plan_name": "Wellcare Insurance Exchange", "methodology": "fee schedule", "standard_charge_dollar": 61.0, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 61.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup Medicare", "methodology": "fee schedule", "standard_charge_dollar": 61.0, "additional_payer_notes": "100.00% of Medicare Rates" } ] } ] }, { "description": "Hc Stemi Intervent Des", "code_information": [ { "code": "C9606", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 36934.1, "minimum": 688.0, "maximum": 29547.28, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 688.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC All Payer (02-01-2023 to 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 4889.0 }, { "payer_name": "UHC", "plan_name": "UHC Oxford (02-01-2023 to 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 4020.0 }, { "payer_name": "UHC - Adhoc", "plan_name": "UHC - Adhoc All Payer", "methodology": "case rate", "standard_charge_dollar": 5190.0 }, { "payer_name": "UHC - Adhoc", "plan_name": "UHC - Adhoc Oxford", "methodology": "case rate", "standard_charge_dollar": 4143.0 }, { "payer_name": "Wellchoice", "plan_name": "WELLCHOICE HMO of NJ (Empire) Commercial (HMO / HMO POS, PPO)", "methodology": "case rate", "standard_charge_dollar": 2472.0 }, { "payer_name": "Wellchoice", "plan_name": "WELLCHOICE HMO of NJ (Empire) Commercial (Indemnity)", "methodology": "case rate", "standard_charge_dollar": 2753.0 } ] } ] }, { "description": "Hc Nasal Endo Sx,Bx/Polypectomy/Debridement", "code_information": [ { "code": "31237", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 4549.5, "discounted_cash": 2104.0, "minimum": 868.4995, "maximum": 12312.0, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 4460.9, "additional_payer_notes": "212.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medical Rental Network", "methodology": "fee schedule", "standard_charge_dollar": 4460.9, "additional_payer_notes": "212.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2104.2, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "ALLY-ALIGN (FKA SPARTAN PLAN NJ, INC.)", "plan_name": "ALLY-ALIGN (FKA SPARTAN PLAN NJ, INC.)", "methodology": "fee schedule", "standard_charge_dollar": 2209.41, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Americhoice (UHC)", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2104.2, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Amerihealth", "plan_name": "Amerihealth Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2104.2, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 3092.12, "additional_payer_notes": "146.95% of Medicare Rates" }, { "payer_name": "Clover Health", "plan_name": "Clover Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2104.2, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Coventry", "plan_name": "Coventry Auto", "methodology": "fee schedule", "standard_charge_dollar": 4208.4, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Coventry", "plan_name": "Coventry Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 4208.4, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "fee schedule", "standard_charge_dollar": 2945.88, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Fairprice Healthcare Holdings", "plan_name": "Fairprice Healthcare Holdings", "methodology": "fee schedule", "standard_charge_dollar": 3366.72, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ HMO POS", "methodology": "fee schedule", "standard_charge_dollar": 3730.75, "additional_payer_notes": "177.30% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ Indemnity", "methodology": "fee schedule", "standard_charge_dollar": 3730.75, "additional_payer_notes": "177.30% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ PPO", "methodology": "fee schedule", "standard_charge_dollar": 3730.75, "additional_payer_notes": "177.30% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2104.2, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Military Tricare", "methodology": "fee schedule", "standard_charge_dollar": 1683.36, "additional_payer_notes": "80.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2104.2, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 2104.2, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC All Payer (02-01-2023 to 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 3912.0 }, { "payer_name": "UHC", "plan_name": "UHC Oxford (02-01-2023 to 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 3676.0 }, { "payer_name": "UHC - Adhoc", "plan_name": "UHC - Adhoc All Payer", "methodology": "case rate", "standard_charge_dollar": 4153.0 }, { "payer_name": "UHC - Adhoc", "plan_name": "UHC - Adhoc Oxford", "methodology": "case rate", "standard_charge_dollar": 3788.0 }, { "payer_name": "Wellcare", "plan_name": "Wellcare Insurance Exchange", "methodology": "fee schedule", "standard_charge_dollar": 2840.67, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2104.2, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellchoice", "plan_name": "WELLCHOICE HMO of NJ (Empire) Commercial (HMO / HMO POS, PPO)", "methodology": "case rate", "standard_charge_dollar": 1715.0 }, { "payer_name": "Wellchoice", "plan_name": "WELLCHOICE HMO of NJ (Empire) Commercial (Indemnity)", "methodology": "case rate", "standard_charge_dollar": 1978.0 }, { "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2104.2, "additional_payer_notes": "100.00% of Medicare Rates" } ] } ] }, { "description": "UTERINE & ADNEXA PROCEDURES FOR OVARIAN & ADNEXAL MALIGNANCY - SOI : 3", "code_information": [ { "code": "5113", "type": "APR-DRG" } ], "standard_charges": [ { "setting": "inpatient", "minimum": 29668.34, "maximum": 32635.17, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Better Health - Medi Medi", "methodology": "case rate", "standard_charge_dollar": 32635.17, "additional_payer_notes": "110% of State Medicaid Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Better Health Medicaid", "methodology": "case rate", "standard_charge_dollar": 32635.17, "additional_payer_notes": "110% of State Medicaid Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "case rate", "standard_charge_dollar": 29668.34, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "UBH", "plan_name": "UBH Medicaid", "methodology": "case rate", "standard_charge_dollar": 29668.34, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicaid (02/01/2023 to 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 30261.7, "additional_payer_notes": "102% of State Medicaid Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicaid", "methodology": "case rate", "standard_charge_dollar": 29668.34, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup Medicaid", "methodology": "case rate", "standard_charge_dollar": 29668.34, "additional_payer_notes": "100% of State Medicaid Rates" } ] } ] }, { "description": "ACUTE LEUKEMIA - SOI : 2", "code_information": [ { "code": "6902", "type": "APR-DRG" } ], "standard_charges": [ { "setting": "inpatient", "minimum": 19861.36, "maximum": 21847.5, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Better Health - Medi Medi", "methodology": "case rate", "standard_charge_dollar": 21847.5, "additional_payer_notes": "110% of State Medicaid Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Better Health Medicaid", "methodology": "case rate", "standard_charge_dollar": 21847.5, "additional_payer_notes": "110% of State Medicaid Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "case rate", "standard_charge_dollar": 19861.36, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "UBH", "plan_name": "UBH Medicaid", "methodology": "case rate", "standard_charge_dollar": 19861.36, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicaid (02/01/2023 to 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 20258.59, "additional_payer_notes": "102% of State Medicaid Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicaid", "methodology": "case rate", "standard_charge_dollar": 19861.36, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup Medicaid", "methodology": "case rate", "standard_charge_dollar": 19861.36, "additional_payer_notes": "100% of State Medicaid Rates" } ] } ] }, { "description": "Sho arthrs srg lmtd dbrdmt", "code_information": [ { "code": "29822", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 24355.25, "discounted_cash": 3868.0, "minimum": 1715.0, "maximum": 19484.2, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 8200.52, "additional_payer_notes": "212.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medical Rental Network", "methodology": "fee schedule", "standard_charge_dollar": 8200.52, "additional_payer_notes": "212.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3868.17, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "ALLY-ALIGN (FKA SPARTAN PLAN NJ, INC.)", "plan_name": "ALLY-ALIGN (FKA SPARTAN PLAN NJ, INC.)", "methodology": "fee schedule", "standard_charge_dollar": 4061.58, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Americhoice (UHC)", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3868.17, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Amerihealth", "plan_name": "Amerihealth Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3868.17, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 5684.28, "additional_payer_notes": "146.95% of Medicare Rates" }, { "payer_name": "Clover Health", "plan_name": "Clover Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3868.17, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Coventry", "plan_name": "Coventry Auto", "methodology": "fee schedule", "standard_charge_dollar": 7736.34, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Coventry", "plan_name": "Coventry Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 7736.34, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "fee schedule", "standard_charge_dollar": 5415.44, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Fairprice Healthcare Holdings", "plan_name": "Fairprice Healthcare Holdings", "methodology": "fee schedule", "standard_charge_dollar": 6189.07, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ HMO POS", "methodology": "fee schedule", "standard_charge_dollar": 6858.27, "additional_payer_notes": "177.30% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ Indemnity", "methodology": "fee schedule", "standard_charge_dollar": 6858.27, "additional_payer_notes": "177.30% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ PPO", "methodology": "fee schedule", "standard_charge_dollar": 6858.27, "additional_payer_notes": "177.30% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3868.17, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Military Tricare", "methodology": "fee schedule", "standard_charge_dollar": 3094.54, "additional_payer_notes": "80.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3868.17, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 3868.17, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC All Payer (02-01-2023 to 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 5378.0 }, { "payer_name": "UHC", "plan_name": "UHC Oxford (02-01-2023 to 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 5169.0 }, { "payer_name": "UHC - Adhoc", "plan_name": "UHC - Adhoc All Payer", "methodology": "case rate", "standard_charge_dollar": 5709.0 }, { "payer_name": "UHC - Adhoc", "plan_name": "UHC - Adhoc Oxford", "methodology": "case rate", "standard_charge_dollar": 5327.0 }, { "payer_name": "Wellcare", "plan_name": "Wellcare Insurance Exchange", "methodology": "fee schedule", "standard_charge_dollar": 5222.03, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3868.17, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellchoice", "plan_name": "WELLCHOICE HMO of NJ (Empire) Commercial (HMO / HMO POS, PPO)", "methodology": "case rate", "standard_charge_dollar": 1715.0 }, { "payer_name": "Wellchoice", "plan_name": "WELLCHOICE HMO of NJ (Empire) Commercial (Indemnity)", "methodology": "case rate", "standard_charge_dollar": 1978.0 }, { "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3868.17, "additional_payer_notes": "100.00% of Medicare Rates" } ] } ] }, { "description": "CAROTID ARTERY STENT PROCEDURES WITHOUT CCMCC", "code_information": [ { "code": "036", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 24008.0, "minimum": 10777.72, "maximum": 43455.6203, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "case rate", "standard_charge_dollar": 43455.62, "additional_payer_notes": "181.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medical Rental Network", "methodology": "case rate", "standard_charge_dollar": 43455.62, "additional_payer_notes": "181.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "case rate", "standard_charge_dollar": 19585.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "ALLY-ALIGN (FKA SPARTAN PLAN NJ, INC.)", "plan_name": "ALLY-ALIGN (FKA SPARTAN PLAN NJ, INC.)", "methodology": "case rate", "standard_charge_dollar": 25209.06, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Americhoice (UHC)", "plan_name": "UHC Medicare", "methodology": "case rate", "standard_charge_dollar": 19585.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Amerihealth", "plan_name": "Amerihealth Medicare", "methodology": "case rate", "standard_charge_dollar": 19585.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Commercial", "methodology": "case rate", "standard_charge_dollar": 28423.16 }, { "payer_name": "Clover Health", "plan_name": "Clover Medicare", "methodology": "case rate", "standard_charge_dollar": 19585.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Coventry", "plan_name": "Coventry Auto", "methodology": "case rate", "standard_charge_dollar": 40814.67, "additional_payer_notes": "170.00% of Medicare Rates" }, { "payer_name": "Coventry", "plan_name": "Coventry Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 40814.67, "additional_payer_notes": "170.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "case rate", "standard_charge_dollar": 31211.22, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Fairprice Healthcare Holdings", "plan_name": "Fairprice Healthcare Holdings", "methodology": "case rate", "standard_charge_dollar": 38413.81, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon Medicare", "methodology": "case rate", "standard_charge_dollar": 19585.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon NJ Health Medicaid", "methodology": "case rate", "standard_charge_dollar": 10777.72 }, { "payer_name": "Humana", "plan_name": "Humana Military Tricare", "methodology": "case rate", "standard_charge_dollar": 19206.9, "additional_payer_notes": "80.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 24008.63, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 29500.2 }, { "payer_name": "UBH", "plan_name": "UBH Medicare", "methodology": "case rate", "standard_charge_dollar": 19585.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC All Payer (02-01-2023 to 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 32747.84 }, { "payer_name": "UHC", "plan_name": "UHC Oxford (02-01-2023 to 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 28539.73 }, { "payer_name": "UHC - Adhoc", "plan_name": "UHC - Adhoc All Payer", "methodology": "case rate", "standard_charge_dollar": 34762.52 }, { "payer_name": "UHC - Adhoc", "plan_name": "UHC - Adhoc Oxford", "methodology": "case rate", "standard_charge_dollar": 29410.11 }, { "payer_name": "Wellcare", "plan_name": "Wellcare Insurance Exchange", "methodology": "case rate", "standard_charge_dollar": 32411.65, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "case rate", "standard_charge_dollar": 19585.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup Medicare", "methodology": "case rate", "standard_charge_dollar": 19585.0, "additional_payer_notes": "100.00% of Medicare Rates" } ] } ] }, { "description": "Hc Cns Dna/Rna Amp Probe Multiple Subtypes 12-25", "code_information": [ { "code": "87483", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 1625.91, "discounted_cash": 416.0, "minimum": 250.07, "maximum": 1382.0235, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 883.57, "additional_payer_notes": "212.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medical Rental Network", "methodology": "fee schedule", "standard_charge_dollar": 883.57, "additional_payer_notes": "212.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 416.78, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "ALLY-ALIGN (FKA SPARTAN PLAN NJ, INC.)", "plan_name": "ALLY-ALIGN (FKA SPARTAN PLAN NJ, INC.)", "methodology": "fee schedule", "standard_charge_dollar": 437.62, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Americhoice (UHC)", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 416.78, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Amerihealth", "plan_name": "Amerihealth Medicare", "methodology": "fee schedule", "standard_charge_dollar": 416.78, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 604.33, "additional_payer_notes": "Laboratory - 145.00% of Medicare Rates" }, { "payer_name": "Clover Health", "plan_name": "Clover Medicare", "methodology": "fee schedule", "standard_charge_dollar": 416.78, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Coventry", "plan_name": "Coventry Auto", "methodology": "fee schedule", "standard_charge_dollar": 833.56, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Coventry", "plan_name": "Coventry Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 833.56, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "fee schedule", "standard_charge_dollar": 583.49, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Fairprice Healthcare Holdings", "plan_name": "Fairprice Healthcare Holdings", "methodology": "fee schedule", "standard_charge_dollar": 500.14, "additional_payer_notes": "Laboratory - 120.00% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ HMO POS", "methodology": "fee schedule", "standard_charge_dollar": 1147.89, "additional_payer_notes": "177.30% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ Indemnity", "methodology": "fee schedule", "standard_charge_dollar": 1147.89, "additional_payer_notes": "177.30% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ PPO", "methodology": "fee schedule", "standard_charge_dollar": 1147.89, "additional_payer_notes": "177.30% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon Medicare", "methodology": "fee schedule", "standard_charge_dollar": 416.78, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Military Tricare", "methodology": "fee schedule", "standard_charge_dollar": 333.42, "additional_payer_notes": "80.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 416.78, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 416.78, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC All Payer (02-01-2023 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 250.07 }, { "payer_name": "UHC", "plan_name": "UHC Medicaid (02/01/2023 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 333.42 }, { "payer_name": "UHC", "plan_name": "UHC Oxford (02-01-2023 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 250.07 }, { "payer_name": "UHC - Adhoc", "plan_name": "UHC - Adhoc All Payer", "methodology": "fee schedule", "standard_charge_dollar": 416.78 }, { "payer_name": "UHC - Adhoc", "plan_name": "UHC - Adhoc Oxford", "methodology": "fee schedule", "standard_charge_dollar": 416.78 }, { "payer_name": "Wellcare", "plan_name": "Wellcare Insurance Exchange", "methodology": "fee schedule", "standard_charge_dollar": 562.65, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 416.78, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup Medicare", "methodology": "fee schedule", "standard_charge_dollar": 416.78, "additional_payer_notes": "100.00% of Medicare Rates" } ] } ] }, { "description": "Hc Needle Biopsy,Muscle", "code_information": [ { "code": "20206", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 6863.0, "discounted_cash": 1952.0, "minimum": 1310.1467, "maximum": 5490.4, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 4139.36, "additional_payer_notes": "212.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medical Rental Network", "methodology": "fee schedule", "standard_charge_dollar": 4139.36, "additional_payer_notes": "212.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1952.53, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "ALLY-ALIGN (FKA SPARTAN PLAN NJ, INC.)", "plan_name": "ALLY-ALIGN (FKA SPARTAN PLAN NJ, INC.)", "methodology": "fee schedule", "standard_charge_dollar": 2050.16, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Americhoice (UHC)", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1952.53, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Amerihealth", "plan_name": "Amerihealth Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1952.53, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 2869.24, "additional_payer_notes": "146.95% of Medicare Rates" }, { "payer_name": "Clover Health", "plan_name": "Clover Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1952.53, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Coventry", "plan_name": "Coventry Auto", "methodology": "fee schedule", "standard_charge_dollar": 3905.06, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Coventry", "plan_name": "Coventry Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 3905.06, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "fee schedule", "standard_charge_dollar": 2733.54, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Fairprice Healthcare Holdings", "plan_name": "Fairprice Healthcare Holdings", "methodology": "fee schedule", "standard_charge_dollar": 3124.05, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ HMO POS", "methodology": "fee schedule", "standard_charge_dollar": 3461.84, "additional_payer_notes": "177.30% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ Indemnity", "methodology": "fee schedule", "standard_charge_dollar": 3461.84, "additional_payer_notes": "177.30% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ PPO", "methodology": "fee schedule", "standard_charge_dollar": 3461.84, "additional_payer_notes": "177.30% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1952.53, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Military Tricare", "methodology": "fee schedule", "standard_charge_dollar": 1562.02, "additional_payer_notes": "80.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1952.53, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 1952.53, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC All Payer (02-01-2023 to 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 3912.0 }, { "payer_name": "UHC", "plan_name": "UHC Oxford (02-01-2023 to 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 3676.0 }, { "payer_name": "UHC - Adhoc", "plan_name": "UHC - Adhoc All Payer", "methodology": "case rate", "standard_charge_dollar": 4153.0 }, { "payer_name": "UHC - Adhoc", "plan_name": "UHC - Adhoc Oxford", "methodology": "case rate", "standard_charge_dollar": 3788.0 }, { "payer_name": "Wellcare", "plan_name": "Wellcare Insurance Exchange", "methodology": "fee schedule", "standard_charge_dollar": 2635.92, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1952.53, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellchoice", "plan_name": "WELLCHOICE HMO of NJ (Empire) Commercial (HMO / HMO POS, PPO)", "methodology": "case rate", "standard_charge_dollar": 1715.0 }, { "payer_name": "Wellchoice", "plan_name": "WELLCHOICE HMO of NJ (Empire) Commercial (Indemnity)", "methodology": "case rate", "standard_charge_dollar": 1978.0 }, { "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1952.53, "additional_payer_notes": "100.00% of Medicare Rates" } ] } ] }, { "description": "MUSCULOSKELETAL MALIGNANCY & PATHOL FRACTURE DT MUSCSKEL MALIG - SOI : 1", "code_information": [ { "code": "3431", "type": "APR-DRG" } ], "standard_charges": [ { "setting": "inpatient", "minimum": 9429.26, "maximum": 10372.18, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Better Health - Medi Medi", "methodology": "case rate", "standard_charge_dollar": 10372.18, "additional_payer_notes": "110% of State Medicaid Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Better Health Medicaid", "methodology": "case rate", "standard_charge_dollar": 10372.18, "additional_payer_notes": "110% of State Medicaid Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "case rate", "standard_charge_dollar": 9429.26, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "UBH", "plan_name": "UBH Medicaid", "methodology": "case rate", "standard_charge_dollar": 9429.26, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicaid (02/01/2023 to 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 9617.84, "additional_payer_notes": "102% of State Medicaid Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicaid", "methodology": "case rate", "standard_charge_dollar": 9429.26, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup Medicaid", "methodology": "case rate", "standard_charge_dollar": 9429.26, "additional_payer_notes": "100% of State Medicaid Rates" } ] } ] }, { "description": "UTERINE AND ADNEXA PROCEDURES FOR OVARIAN OR ADNEXAL MALIGNANCY WITHOUT CCMCC", "code_information": [ { "code": "738", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 18527.0, "minimum": 8693.99, "maximum": 33534.594, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "case rate", "standard_charge_dollar": 33534.59, "additional_payer_notes": "181.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medical Rental Network", "methodology": "case rate", "standard_charge_dollar": 33534.59, "additional_payer_notes": "181.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "case rate", "standard_charge_dollar": 15183.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "ALLY-ALIGN (FKA SPARTAN PLAN NJ, INC.)", "plan_name": "ALLY-ALIGN (FKA SPARTAN PLAN NJ, INC.)", "methodology": "case rate", "standard_charge_dollar": 19453.77, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Americhoice (UHC)", "plan_name": "UHC Medicare", "methodology": "case rate", "standard_charge_dollar": 15183.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Amerihealth", "plan_name": "Amerihealth Medicare", "methodology": "case rate", "standard_charge_dollar": 15183.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Commercial", "methodology": "case rate", "standard_charge_dollar": 21484.16 }, { "payer_name": "Clover Health", "plan_name": "Clover Medicare", "methodology": "case rate", "standard_charge_dollar": 15183.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Coventry", "plan_name": "Coventry Auto", "methodology": "case rate", "standard_charge_dollar": 31496.58, "additional_payer_notes": "170.00% of Medicare Rates" }, { "payer_name": "Coventry", "plan_name": "Coventry Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 31496.58, "additional_payer_notes": "170.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "case rate", "standard_charge_dollar": 24085.62, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Fairprice Healthcare Holdings", "plan_name": "Fairprice Healthcare Holdings", "methodology": "case rate", "standard_charge_dollar": 29643.84, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon Medicare", "methodology": "case rate", "standard_charge_dollar": 15183.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon NJ Health Medicaid", "methodology": "case rate", "standard_charge_dollar": 8693.99 }, { "payer_name": "Humana", "plan_name": "Humana Military Tricare", "methodology": "case rate", "standard_charge_dollar": 14821.92, "additional_payer_notes": "80.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 18527.4, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 20261.0 }, { "payer_name": "UBH", "plan_name": "UBH Medicare", "methodology": "case rate", "standard_charge_dollar": 15183.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC All Payer (02-01-2023 to 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 24753.04 }, { "payer_name": "UHC", "plan_name": "UHC Oxford (02-01-2023 to 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 21572.27 }, { "payer_name": "UHC - Adhoc", "plan_name": "UHC - Adhoc All Payer", "methodology": "case rate", "standard_charge_dollar": 26275.87 }, { "payer_name": "UHC - Adhoc", "plan_name": "UHC - Adhoc Oxford", "methodology": "case rate", "standard_charge_dollar": 22230.15 }, { "payer_name": "Wellcare", "plan_name": "Wellcare Insurance Exchange", "methodology": "case rate", "standard_charge_dollar": 25011.99, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "case rate", "standard_charge_dollar": 15183.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup Medicare", "methodology": "case rate", "standard_charge_dollar": 15183.7, "additional_payer_notes": "100.00% of Medicare Rates" } ] } ] }, { "description": "Biopsy Of Prostate", "code_information": [ { "code": "55700", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 15664.3, "discounted_cash": 2370.0, "minimum": 1715.0, "maximum": 12531.44, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 5025.27, "additional_payer_notes": "212.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medical Rental Network", "methodology": "fee schedule", "standard_charge_dollar": 5025.27, "additional_payer_notes": "212.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2370.41, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "ALLY-ALIGN (FKA SPARTAN PLAN NJ, INC.)", "plan_name": "ALLY-ALIGN (FKA SPARTAN PLAN NJ, INC.)", "methodology": "fee schedule", "standard_charge_dollar": 2488.93, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Americhoice (UHC)", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2370.41, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Amerihealth", "plan_name": "Amerihealth Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2370.41, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 3483.32, "additional_payer_notes": "146.95% of Medicare Rates" }, { "payer_name": "Clover Health", "plan_name": "Clover Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2370.41, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Coventry", "plan_name": "Coventry Auto", "methodology": "fee schedule", "standard_charge_dollar": 4740.82, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Coventry", "plan_name": "Coventry Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 4740.82, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "fee schedule", "standard_charge_dollar": 3318.57, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Fairprice Healthcare Holdings", "plan_name": "Fairprice Healthcare Holdings", "methodology": "fee schedule", "standard_charge_dollar": 3792.66, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ HMO POS", "methodology": "fee schedule", "standard_charge_dollar": 4202.74, "additional_payer_notes": "177.30% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ Indemnity", "methodology": "fee schedule", "standard_charge_dollar": 4202.74, "additional_payer_notes": "177.30% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ PPO", "methodology": "fee schedule", "standard_charge_dollar": 4202.74, "additional_payer_notes": "177.30% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2370.41, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Military Tricare", "methodology": "fee schedule", "standard_charge_dollar": 1896.33, "additional_payer_notes": "80.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2370.41, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 2370.41, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC - Adhoc", "plan_name": "UHC - Adhoc All Payer", "methodology": "case rate", "standard_charge_dollar": 4153.0 }, { "payer_name": "UHC - Adhoc", "plan_name": "UHC - Adhoc Oxford", "methodology": "case rate", "standard_charge_dollar": 3788.0 }, { "payer_name": "Wellcare", "plan_name": "Wellcare Insurance Exchange", "methodology": "fee schedule", "standard_charge_dollar": 3200.05, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2370.41, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellchoice", "plan_name": "WELLCHOICE HMO of NJ (Empire) Commercial (HMO / HMO POS, PPO)", "methodology": "case rate", "standard_charge_dollar": 1715.0 }, { "payer_name": "Wellchoice", "plan_name": "WELLCHOICE HMO of NJ (Empire) Commercial (Indemnity)", "methodology": "case rate", "standard_charge_dollar": 1978.0 }, { "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2370.41, "additional_payer_notes": "100.00% of Medicare Rates" } ] } ] }, { "description": "CARDIAC DEFIBRILLATOR IMPLANT WITH MCC", "code_information": [ { "code": "276", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 70971.0, "minimum": 49381.0, "maximum": 128458.9761, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "case rate", "standard_charge_dollar": 128458.98, "additional_payer_notes": "181.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medical Rental Network", "methodology": "case rate", "standard_charge_dollar": 128458.98, "additional_payer_notes": "181.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "case rate", "standard_charge_dollar": 57295.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "ALLY-ALIGN (FKA SPARTAN PLAN NJ, INC.)", "plan_name": "ALLY-ALIGN (FKA SPARTAN PLAN NJ, INC.)", "methodology": "case rate", "standard_charge_dollar": 74520.4, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Americhoice (UHC)", "plan_name": "UHC Medicare", "methodology": "case rate", "standard_charge_dollar": 57295.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Amerihealth", "plan_name": "Amerihealth Medicare", "methodology": "case rate", "standard_charge_dollar": 57295.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Commercial", "methodology": "case rate", "standard_charge_dollar": 87876.56 }, { "payer_name": "Clover Health", "plan_name": "Clover Medicare", "methodology": "case rate", "standard_charge_dollar": 57295.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Coventry", "plan_name": "Coventry Auto", "methodology": "case rate", "standard_charge_dollar": 120652.08, "additional_payer_notes": "170.00% of Medicare Rates" }, { "payer_name": "Coventry", "plan_name": "Coventry Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 120652.08, "additional_payer_notes": "170.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "case rate", "standard_charge_dollar": 92263.35, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Fairprice Healthcare Holdings", "plan_name": "Fairprice Healthcare Holdings", "methodology": "case rate", "standard_charge_dollar": 113554.9, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon Medicare", "methodology": "case rate", "standard_charge_dollar": 57295.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Military Tricare", "methodology": "case rate", "standard_charge_dollar": 56777.45, "additional_payer_notes": "80.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 70971.81, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 49381.0 }, { "payer_name": "UBH", "plan_name": "UBH Medicare", "methodology": "case rate", "standard_charge_dollar": 57295.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC All Payer (02-01-2023 to 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 101247.25 }, { "payer_name": "UHC", "plan_name": "UHC Oxford (02-01-2023 to 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 88236.95 }, { "payer_name": "UHC - Adhoc", "plan_name": "UHC - Adhoc All Payer", "methodology": "case rate", "standard_charge_dollar": 107476.09 }, { "payer_name": "UHC - Adhoc", "plan_name": "UHC - Adhoc Oxford", "methodology": "case rate", "standard_charge_dollar": 90927.91 }, { "payer_name": "Wellcare", "plan_name": "Wellcare Insurance Exchange", "methodology": "case rate", "standard_charge_dollar": 95811.94, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "case rate", "standard_charge_dollar": 57295.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup Medicare", "methodology": "case rate", "standard_charge_dollar": 57295.1, "additional_payer_notes": "100.00% of Medicare Rates" } ] } ] }, { "description": "OPEN CRANIOTOMY FOR TRAUMA- SOI : 2", "code_information": [ { "code": "0202", "type": "APR-DRG" } ], "standard_charges": [ { "setting": "inpatient", "minimum": 30608.05, "maximum": 33668.85, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Better Health - Medi Medi", "methodology": "case rate", "standard_charge_dollar": 33668.85, "additional_payer_notes": "110% of State Medicaid Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Better Health Medicaid", "methodology": "case rate", "standard_charge_dollar": 33668.85, "additional_payer_notes": "110% of State Medicaid Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "case rate", "standard_charge_dollar": 30608.05, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "UBH", "plan_name": "UBH Medicaid", "methodology": "case rate", "standard_charge_dollar": 30608.05, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicaid (02/01/2023 to 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 31220.21, "additional_payer_notes": "102% of State Medicaid Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicaid", "methodology": "case rate", "standard_charge_dollar": 30608.05, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup Medicaid", "methodology": "case rate", "standard_charge_dollar": 30608.05, "additional_payer_notes": "100% of State Medicaid Rates" } ] } ] }, { "description": "Hc Nm Hepatobiliary Syst Imaging Including Gallbladdr", "code_information": [ { "code": "78226", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 2135.09, "discounted_cash": 472.0, "minimum": 286.94, "maximum": 1814.8265, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 1001.91, "additional_payer_notes": "212.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medical Rental Network", "methodology": "fee schedule", "standard_charge_dollar": 1001.91, "additional_payer_notes": "212.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 472.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "ALLY-ALIGN (FKA SPARTAN PLAN NJ, INC.)", "plan_name": "ALLY-ALIGN (FKA SPARTAN PLAN NJ, INC.)", "methodology": "fee schedule", "standard_charge_dollar": 496.23, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Americhoice (UHC)", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 472.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Amerihealth", "plan_name": "Amerihealth HMO", "methodology": "fee schedule", "standard_charge_dollar": 286.94 }, { "payer_name": "Amerihealth", "plan_name": "Amerihealth Medicare", "methodology": "fee schedule", "standard_charge_dollar": 472.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 694.49, "additional_payer_notes": "146.95% of Medicare Rates" }, { "payer_name": "Clover Health", "plan_name": "Clover Medicare", "methodology": "fee schedule", "standard_charge_dollar": 472.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Coventry", "plan_name": "Coventry Auto", "methodology": "fee schedule", "standard_charge_dollar": 945.2, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Coventry", "plan_name": "Coventry Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 945.2, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "fee schedule", "standard_charge_dollar": 661.64, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Fairprice Healthcare Holdings", "plan_name": "Fairprice Healthcare Holdings", "methodology": "fee schedule", "standard_charge_dollar": 756.16, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ HMO POS", "methodology": "fee schedule", "standard_charge_dollar": 837.92, "additional_payer_notes": "177.30% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ Indemnity", "methodology": "fee schedule", "standard_charge_dollar": 837.92, "additional_payer_notes": "177.30% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ PPO", "methodology": "fee schedule", "standard_charge_dollar": 837.92, "additional_payer_notes": "177.30% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon Medicare", "methodology": "fee schedule", "standard_charge_dollar": 472.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon NJ Health Medicaid", "methodology": "percent of total billed charges", "standard_charge_percentage": 19.58, "median_amount": 418.05, "10th_percentile": 418.05, "90th_percentile": 418.05, "count": "1 through 10" }, { "payer_name": "Humana", "plan_name": "Humana Military Tricare", "methodology": "fee schedule", "standard_charge_dollar": 378.08, "additional_payer_notes": "80.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 472.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 472.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC All Payer (02-01-2023 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 565.68 }, { "payer_name": "UHC", "plan_name": "UHC Medicaid (02/01/2023 to 12-31-2026)", "methodology": "percent of total billed charges", "standard_charge_percentage": 19.47, "median_amount": 406.15, "10th_percentile": 406.15, "90th_percentile": 406.15, "count": "1 through 10" }, { "payer_name": "UHC", "plan_name": "UHC Oxford (02-01-2023 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 565.68 }, { "payer_name": "UHC - Adhoc", "plan_name": "UHC - Adhoc All Payer", "methodology": "fee schedule", "standard_charge_dollar": 377.12 }, { "payer_name": "UHC - Adhoc", "plan_name": "UHC - Adhoc Oxford", "methodology": "fee schedule", "standard_charge_dollar": 377.12 }, { "payer_name": "Wellcare", "plan_name": "Wellcare Insurance Exchange", "methodology": "fee schedule", "standard_charge_dollar": 638.01, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 472.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup Medicaid", "methodology": "percent of total billed charges", "standard_charge_percentage": 19.09, "median_amount": 398.19, "10th_percentile": 398.19, "90th_percentile": 398.19, "count": "1 through 10" }, { "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup Medicare", "methodology": "fee schedule", "standard_charge_dollar": 472.6, "additional_payer_notes": "100.00% of Medicare Rates" } ] } ] }, { "description": "BEHAVIORAL DISORDERS - SOI : 3", "code_information": [ { "code": "7583", "type": "APR-DRG" } ], "standard_charges": [ { "setting": "inpatient", "minimum": 9920.36, "maximum": 10912.39, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Better Health - Medi Medi", "methodology": "case rate", "standard_charge_dollar": 10912.39, "additional_payer_notes": "110% of State Medicaid Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Better Health Medicaid", "methodology": "case rate", "standard_charge_dollar": 10912.39, "additional_payer_notes": "110% of State Medicaid Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "case rate", "standard_charge_dollar": 9920.36, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "UBH", "plan_name": "UBH Medicaid", "methodology": "case rate", "standard_charge_dollar": 9920.36, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicaid (02/01/2023 to 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 10118.77, "additional_payer_notes": "102% of State Medicaid Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicaid", "methodology": "case rate", "standard_charge_dollar": 9920.36, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup Medicaid", "methodology": "case rate", "standard_charge_dollar": 9920.36, "additional_payer_notes": "100% of State Medicaid Rates" } ] } ] }, { "description": "TRACHEOSTOMY W MV 96+ HOURS WO EXTENSIVE PROCEDURE - SOI : 3", "code_information": [ { "code": "0053", "type": "APR-DRG" } ], "standard_charges": [ { "setting": "inpatient", "minimum": 94821.07, "maximum": 104303.18, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Better Health - Medi Medi", "methodology": "case rate", "standard_charge_dollar": 104303.18, "additional_payer_notes": "110% of State Medicaid Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Better Health Medicaid", "methodology": "case rate", "standard_charge_dollar": 104303.18, "additional_payer_notes": "110% of State Medicaid Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "case rate", "standard_charge_dollar": 94821.07, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "UBH", "plan_name": "UBH Medicaid", "methodology": "case rate", "standard_charge_dollar": 94821.07, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicaid (02/01/2023 to 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 96717.5, "additional_payer_notes": "102% of State Medicaid Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicaid", "methodology": "case rate", "standard_charge_dollar": 94821.07, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup Medicaid", "methodology": "case rate", "standard_charge_dollar": 94821.07, "additional_payer_notes": "100% of State Medicaid Rates" } ] } ] }, { "description": "Hc Observation Per Hour", "code_information": [ { "code": "G0378", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "payers_information": [ { "payer_name": "Horizon", "plan_name": "Horizon NJ Health Medicaid", "methodology": "percent of total billed charges", "standard_charge_percentage": 19.58, "median_amount": 272.55, "10th_percentile": 68.14, "90th_percentile": 1174.8, "count": "193" }, { "payer_name": "UHC", "plan_name": "UHC Medicaid (02/01/2023 to 12-31-2026)", "methodology": "percent of total billed charges", "standard_charge_percentage": 19.47, "median_amount": 1141.38, "10th_percentile": 264.8, "90th_percentile": 2282.76, "count": "41" }, { "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup Medicaid", "methodology": "percent of total billed charges", "standard_charge_percentage": 19.09, "median_amount": 162.26, "10th_percentile": 32.45, "90th_percentile": 1119.0, "count": "148" } ] } ] }, { "description": "OTHER BACK & NECK DISORDERS, FRACTURES & INJURIES - SOI : 1", "code_information": [ { "code": "3471", "type": "APR-DRG" } ], "standard_charges": [ { "setting": "inpatient", "minimum": 7494.44, "maximum": 8243.89, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Better Health - Medi Medi", "methodology": "case rate", "standard_charge_dollar": 8243.89, "additional_payer_notes": "110% of State Medicaid Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Better Health Medicaid", "methodology": "case rate", "standard_charge_dollar": 8243.89, "additional_payer_notes": "110% of State Medicaid Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "case rate", "standard_charge_dollar": 7494.44, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "UBH", "plan_name": "UBH Medicaid", "methodology": "case rate", "standard_charge_dollar": 7494.44, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicaid (02/01/2023 to 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 7644.33, "additional_payer_notes": "102% of State Medicaid Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicaid", "methodology": "case rate", "standard_charge_dollar": 7494.44, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup Medicaid", "methodology": "case rate", "standard_charge_dollar": 7494.44, "additional_payer_notes": "100% of State Medicaid Rates" } ] } ] }, { "description": "FACIAL BONE PROCEDURES EXCEPT MAJOR CRANIALFACIAL BONE PROCEDURES - SOI : 3", "code_information": [ { "code": "0923", "type": "APR-DRG" } ], "standard_charges": [ { "setting": "inpatient", "minimum": 32377.82, "maximum": 35615.6, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Better Health - Medi Medi", "methodology": "case rate", "standard_charge_dollar": 35615.6, "additional_payer_notes": "110% of State Medicaid Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Better Health Medicaid", "methodology": "case rate", "standard_charge_dollar": 35615.6, "additional_payer_notes": "110% of State Medicaid Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "case rate", "standard_charge_dollar": 32377.82, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "UBH", "plan_name": "UBH Medicaid", "methodology": "case rate", "standard_charge_dollar": 32377.82, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicaid (02/01/2023 to 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 33025.38, "additional_payer_notes": "102% of State Medicaid Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicaid", "methodology": "case rate", "standard_charge_dollar": 32377.82, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup Medicaid", "methodology": "case rate", "standard_charge_dollar": 32377.82, "additional_payer_notes": "100% of State Medicaid Rates" } ] } ] }, { "description": "BACTERIAL & TUBERCULOUS INFECTIONS OF NERVOUS SYSTEM - SOI : 3", "code_information": [ { "code": "0493", "type": "APR-DRG" } ], "standard_charges": [ { "setting": "inpatient", "minimum": 25878.55, "maximum": 28466.41, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Better Health - Medi Medi", "methodology": "case rate", "standard_charge_dollar": 28466.41, "additional_payer_notes": "110% of State Medicaid Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Better Health Medicaid", "methodology": "case rate", "standard_charge_dollar": 28466.41, "additional_payer_notes": "110% of State Medicaid Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "case rate", "standard_charge_dollar": 25878.55, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "UBH", "plan_name": "UBH Medicaid", "methodology": "case rate", "standard_charge_dollar": 25878.55, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicaid (02/01/2023 to 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 26396.12, "additional_payer_notes": "102% of State Medicaid Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicaid", "methodology": "case rate", "standard_charge_dollar": 25878.55, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup Medicaid", "methodology": "case rate", "standard_charge_dollar": 25878.55, "additional_payer_notes": "100% of State Medicaid Rates" } ] } ] }, { "description": "Hc Surg Path,Level V", "code_information": [ { "code": "88307", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 1475.63, "discounted_cash": 423.0, "minimum": 170.05, "maximum": 1254.2855, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 898.35, "additional_payer_notes": "212.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medical Rental Network", "methodology": "fee schedule", "standard_charge_dollar": 898.35, "additional_payer_notes": "212.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 423.75, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "ALLY-ALIGN (FKA SPARTAN PLAN NJ, INC.)", "plan_name": "ALLY-ALIGN (FKA SPARTAN PLAN NJ, INC.)", "methodology": "fee schedule", "standard_charge_dollar": 444.94, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Americhoice (UHC)", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 423.75, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Amerihealth", "plan_name": "Amerihealth Medicare", "methodology": "fee schedule", "standard_charge_dollar": 423.75, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 622.7, "additional_payer_notes": "146.95% of Medicare Rates" }, { "payer_name": "Clover Health", "plan_name": "Clover Medicare", "methodology": "fee schedule", "standard_charge_dollar": 423.75, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Coventry", "plan_name": "Coventry Auto", "methodology": "fee schedule", "standard_charge_dollar": 847.5, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Coventry", "plan_name": "Coventry Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 847.5, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "fee schedule", "standard_charge_dollar": 593.25, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Fairprice Healthcare Holdings", "plan_name": "Fairprice Healthcare Holdings", "methodology": "fee schedule", "standard_charge_dollar": 678.0, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ HMO POS", "methodology": "fee schedule", "standard_charge_dollar": 751.31, "additional_payer_notes": "177.30% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ Indemnity", "methodology": "fee schedule", "standard_charge_dollar": 751.31, "additional_payer_notes": "177.30% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ PPO", "methodology": "fee schedule", "standard_charge_dollar": 751.31, "additional_payer_notes": "177.30% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon Medicare", "methodology": "fee schedule", "standard_charge_dollar": 423.75, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon NJ Health Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 235.21 }, { "payer_name": "Humana", "plan_name": "Humana Military Tricare", "methodology": "fee schedule", "standard_charge_dollar": 339.0, "additional_payer_notes": "80.00% of Medicare Rates" }, { "payer_name": "Keenan", "plan_name": "Keenan", "methodology": "percent of total billed charges", "standard_charge_percentage": 30.0, "median_amount": 442.69, "10th_percentile": 442.69, "90th_percentile": 442.69, "count": "1 through 10" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 423.75, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 423.75, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC All Payer (02-01-2023 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 170.05 }, { "payer_name": "UHC", "plan_name": "UHC Medicaid (02/01/2023 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 235.21 }, { "payer_name": "UHC", "plan_name": "UHC Oxford (02-01-2023 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 170.05 }, { "payer_name": "UHC - Adhoc", "plan_name": "UHC - Adhoc All Payer", "methodology": "fee schedule", "standard_charge_dollar": 283.41 }, { "payer_name": "UHC - Adhoc", "plan_name": "UHC - Adhoc Oxford", "methodology": "fee schedule", "standard_charge_dollar": 283.41 }, { "payer_name": "Wellcare", "plan_name": "Wellcare Insurance Exchange", "methodology": "fee schedule", "standard_charge_dollar": 572.06, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 423.75, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup Medicaid", "methodology": "percent of total billed charges", "standard_charge_percentage": 19.09, "median_amount": 275.21, "10th_percentile": 125.51, "90th_percentile": 275.21, "count": "1 through 10" }, { "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup Medicare", "methodology": "fee schedule", "standard_charge_dollar": 423.75, "additional_payer_notes": "100.00% of Medicare Rates" } ] } ] }, { "description": "LYMPHATIC & OTHER MALIGNANCIES & NEOPLASMS OF UNCERTAIN BEHAVIOR - SOI : 4", "code_information": [ { "code": "6944", "type": "APR-DRG" } ], "standard_charges": [ { "setting": "inpatient", "minimum": 25762.56, "maximum": 28338.81, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Better Health - Medi Medi", "methodology": "case rate", "standard_charge_dollar": 28338.81, "additional_payer_notes": "110% of State Medicaid Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Better Health Medicaid", "methodology": "case rate", "standard_charge_dollar": 28338.81, "additional_payer_notes": "110% of State Medicaid Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "case rate", "standard_charge_dollar": 25762.56, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "UBH", "plan_name": "UBH Medicaid", "methodology": "case rate", "standard_charge_dollar": 25762.56, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicaid (02/01/2023 to 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 26277.81, "additional_payer_notes": "102% of State Medicaid Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicaid", "methodology": "case rate", "standard_charge_dollar": 25762.56, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup Medicaid", "methodology": "case rate", "standard_charge_dollar": 25762.56, "additional_payer_notes": "100% of State Medicaid Rates" } ] } ] }, { "description": "Dx Bronchoscope/Lavage", "code_information": [ { "code": "31624", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 15870.9, "discounted_cash": 2104.0, "minimum": 57.27, "maximum": 12696.72, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 4460.9, "additional_payer_notes": "212.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medical Rental Network", "methodology": "fee schedule", "standard_charge_dollar": 4460.9, "additional_payer_notes": "212.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2104.2, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "ALLY-ALIGN (FKA SPARTAN PLAN NJ, INC.)", "plan_name": "ALLY-ALIGN (FKA SPARTAN PLAN NJ, INC.)", "methodology": "fee schedule", "standard_charge_dollar": 2209.41, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Americhoice (UHC)", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2104.2, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Amerihealth", "plan_name": "Amerihealth Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2104.2, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 3092.12, "additional_payer_notes": "146.95% of Medicare Rates" }, { "payer_name": "Clover Health", "plan_name": "Clover Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2104.2, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Coventry", "plan_name": "Coventry Auto", "methodology": "fee schedule", "standard_charge_dollar": 4208.4, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Coventry", "plan_name": "Coventry Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 4208.4, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "fee schedule", "standard_charge_dollar": 2945.88, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Fairprice Healthcare Holdings", "plan_name": "Fairprice Healthcare Holdings", "methodology": "fee schedule", "standard_charge_dollar": 3366.72, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ HMO POS", "methodology": "fee schedule", "standard_charge_dollar": 3730.75, "additional_payer_notes": "177.30% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ Indemnity", "methodology": "fee schedule", "standard_charge_dollar": 3730.75, "additional_payer_notes": "177.30% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ PPO", "methodology": "fee schedule", "standard_charge_dollar": 3730.75, "additional_payer_notes": "177.30% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2104.2, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Military Tricare", "methodology": "fee schedule", "standard_charge_dollar": 1683.36, "additional_payer_notes": "80.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2104.2, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 2104.2, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC All Payer (02-01-2023 to 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 3912.0 }, { "payer_name": "UHC", "plan_name": "UHC Medicaid (02/01/2023 to 12-31-2026)", "methodology": "percent of total billed charges", "standard_charge_percentage": 19.47, "median_amount": 2927.64, "10th_percentile": 2927.64, "90th_percentile": 2927.64, "count": "1 through 10" }, { "payer_name": "UHC", "plan_name": "UHC Oxford (02-01-2023 to 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 3676.0 }, { "payer_name": "UHC - Adhoc", "plan_name": "UHC - Adhoc All Payer", "methodology": "case rate", "standard_charge_dollar": 4153.0 }, { "payer_name": "UHC - Adhoc", "plan_name": "UHC - Adhoc Oxford", "methodology": "case rate", "standard_charge_dollar": 3788.0 }, { "payer_name": "Wellcare", "plan_name": "Wellcare Insurance Exchange", "methodology": "fee schedule", "standard_charge_dollar": 2840.67, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2104.2, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellchoice", "plan_name": "WELLCHOICE HMO of NJ (Empire) Commercial (HMO / HMO POS, PPO)", "methodology": "case rate", "standard_charge_dollar": 1715.0 }, { "payer_name": "Wellchoice", "plan_name": "WELLCHOICE HMO of NJ (Empire) Commercial (Indemnity)", "methodology": "case rate", "standard_charge_dollar": 1978.0 }, { "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2104.2, "additional_payer_notes": "100.00% of Medicare Rates" } ] } ] }, { "description": "Hc Fresh Frozen Plasma In 8-24Hr, Per Unit", "code_information": [ { "code": "P9059", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 2582.75, "discounted_cash": 73.0, "minimum": 58.728, "maximum": 2066.2, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 155.63, "additional_payer_notes": "212.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medical Rental Network", "methodology": "fee schedule", "standard_charge_dollar": 155.63, "additional_payer_notes": "212.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 73.41, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "ALLY-ALIGN (FKA SPARTAN PLAN NJ, INC.)", "plan_name": "ALLY-ALIGN (FKA SPARTAN PLAN NJ, INC.)", "methodology": "fee schedule", "standard_charge_dollar": 77.08, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Americhoice (UHC)", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 73.41, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Amerihealth", "plan_name": "Amerihealth Medicare", "methodology": "fee schedule", "standard_charge_dollar": 73.41, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 107.88, "additional_payer_notes": "146.95% of Medicare Rates" }, { "payer_name": "Clover Health", "plan_name": "Clover Medicare", "methodology": "fee schedule", "standard_charge_dollar": 73.41, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Coventry", "plan_name": "Coventry Auto", "methodology": "fee schedule", "standard_charge_dollar": 146.82, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Coventry", "plan_name": "Coventry Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 146.82, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "fee schedule", "standard_charge_dollar": 102.77, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Fairprice Healthcare Holdings", "plan_name": "Fairprice Healthcare Holdings", "methodology": "fee schedule", "standard_charge_dollar": 117.46, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ HMO POS", "methodology": "fee schedule", "standard_charge_dollar": 130.16, "additional_payer_notes": "177.30% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ Indemnity", "methodology": "fee schedule", "standard_charge_dollar": 130.16, "additional_payer_notes": "177.30% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ PPO", "methodology": "fee schedule", "standard_charge_dollar": 130.16, "additional_payer_notes": "177.30% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon Medicare", "methodology": "fee schedule", "standard_charge_dollar": 73.41, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Military Tricare", "methodology": "fee schedule", "standard_charge_dollar": 58.73, "additional_payer_notes": "80.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 73.41, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 73.41, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Insurance Exchange", "methodology": "fee schedule", "standard_charge_dollar": 99.1, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 73.41, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup Medicare", "methodology": "fee schedule", "standard_charge_dollar": 73.41, "additional_payer_notes": "100.00% of Medicare Rates" } ] } ] }, { "description": "Hc Trlml Blln Angiop Open/Perq W/Img S&I Addl Vein", "code_information": [ { "code": "37249", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 22696.1, "minimum": 2297.0, "maximum": 18156.88, "payers_information": [ { "payer_name": "UHC", "plan_name": "UHC All Payer (02-01-2023 to 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 3057.0 }, { "payer_name": "UHC", "plan_name": "UHC Oxford (02-01-2023 to 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 2297.0 }, { "payer_name": "UHC - Adhoc", "plan_name": "UHC - Adhoc All Payer", "methodology": "case rate", "standard_charge_dollar": 3245.0 }, { "payer_name": "UHC - Adhoc", "plan_name": "UHC - Adhoc Oxford", "methodology": "case rate", "standard_charge_dollar": 2367.0 }, { "payer_name": "Wellchoice", "plan_name": "WELLCHOICE HMO of NJ (Empire) Commercial (HMO / HMO POS, PPO)", "methodology": "case rate", "standard_charge_dollar": 2472.0 }, { "payer_name": "Wellchoice", "plan_name": "WELLCHOICE HMO of NJ (Empire) Commercial (Indemnity)", "methodology": "case rate", "standard_charge_dollar": 2753.0 } ] } ] }, { "description": "Hc Coronary Artery Byp W/Vein & Artery Graft 3 Vein", "code_information": [ { "code": "33519", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 800.0, "minimum": 152.72, "maximum": 800.0, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 558.88, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC All Payer (02-01-2023 to 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 800.0 }, { "payer_name": "UHC", "plan_name": "UHC Oxford (02-01-2023 to 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 800.0 }, { "payer_name": "UHC - Adhoc", "plan_name": "UHC - Adhoc All Payer", "methodology": "case rate", "standard_charge_dollar": 800.0 }, { "payer_name": "UHC - Adhoc", "plan_name": "UHC - Adhoc Oxford", "methodology": "case rate", "standard_charge_dollar": 800.0 }, { "payer_name": "Wellchoice", "plan_name": "WELLCHOICE HMO of NJ (Empire) Commercial (HMO / HMO POS, PPO)", "methodology": "case rate", "standard_charge_dollar": 800.0 }, { "payer_name": "Wellchoice", "plan_name": "WELLCHOICE HMO of NJ (Empire) Commercial (Indemnity)", "methodology": "case rate", "standard_charge_dollar": 800.0 } ] } ] }, { "description": "SKIN GRAFT FOR SKIN & SUBCUTANEOUS TISSUE DIAGNOSES - SOI : 1", "code_information": [ { "code": "3611", "type": "APR-DRG" } ], "standard_charges": [ { "setting": "inpatient", "minimum": 17117.0, "maximum": 18828.69, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Better Health - Medi Medi", "methodology": "case rate", "standard_charge_dollar": 18828.69, "additional_payer_notes": "110% of State Medicaid Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Better Health Medicaid", "methodology": "case rate", "standard_charge_dollar": 18828.69, "additional_payer_notes": "110% of State Medicaid Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "case rate", "standard_charge_dollar": 17117.0, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "UBH", "plan_name": "UBH Medicaid", "methodology": "case rate", "standard_charge_dollar": 17117.0, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicaid (02/01/2023 to 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 17459.34, "additional_payer_notes": "102% of State Medicaid Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicaid", "methodology": "case rate", "standard_charge_dollar": 17117.0, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup Medicaid", "methodology": "case rate", "standard_charge_dollar": 17117.0, "additional_payer_notes": "100% of State Medicaid Rates" } ] } ] }, { "description": "Egd Dilate Stricture", "code_information": [ { "code": "43245", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 19235.0, "discounted_cash": 2268.0, "minimum": 1491.2402, "maximum": 15388.0, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 4809.3, "additional_payer_notes": "212.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medical Rental Network", "methodology": "fee schedule", "standard_charge_dollar": 4809.3, "additional_payer_notes": "212.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2268.54, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "ALLY-ALIGN (FKA SPARTAN PLAN NJ, INC.)", "plan_name": "ALLY-ALIGN (FKA SPARTAN PLAN NJ, INC.)", "methodology": "fee schedule", "standard_charge_dollar": 2381.97, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Americhoice (UHC)", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2268.54, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Amerihealth", "plan_name": "Amerihealth Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2268.54, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 3333.62, "additional_payer_notes": "146.95% of Medicare Rates" }, { "payer_name": "Clover Health", "plan_name": "Clover Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2268.54, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Coventry", "plan_name": "Coventry Auto", "methodology": "fee schedule", "standard_charge_dollar": 4537.08, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Coventry", "plan_name": "Coventry Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 4537.08, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "fee schedule", "standard_charge_dollar": 3175.96, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Fairprice Healthcare Holdings", "plan_name": "Fairprice Healthcare Holdings", "methodology": "fee schedule", "standard_charge_dollar": 3629.66, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ HMO POS", "methodology": "fee schedule", "standard_charge_dollar": 4022.12, "additional_payer_notes": "177.30% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ Indemnity", "methodology": "fee schedule", "standard_charge_dollar": 4022.12, "additional_payer_notes": "177.30% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ PPO", "methodology": "fee schedule", "standard_charge_dollar": 4022.12, "additional_payer_notes": "177.30% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2268.54, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Military Tricare", "methodology": "fee schedule", "standard_charge_dollar": 1814.83, "additional_payer_notes": "80.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2268.54, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 2268.54, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC All Payer (02-01-2023 to 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 3912.0 }, { "payer_name": "UHC", "plan_name": "UHC Oxford (02-01-2023 to 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 3676.0 }, { "payer_name": "UHC - Adhoc", "plan_name": "UHC - Adhoc All Payer", "methodology": "case rate", "standard_charge_dollar": 4153.0 }, { "payer_name": "UHC - Adhoc", "plan_name": "UHC - Adhoc Oxford", "methodology": "case rate", "standard_charge_dollar": 3788.0 }, { "payer_name": "Wellcare", "plan_name": "Wellcare Insurance Exchange", "methodology": "fee schedule", "standard_charge_dollar": 3062.53, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2268.54, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellchoice", "plan_name": "WELLCHOICE HMO of NJ (Empire) Commercial (HMO / HMO POS, PPO)", "methodology": "case rate", "standard_charge_dollar": 1715.0 }, { "payer_name": "Wellchoice", "plan_name": "WELLCHOICE HMO of NJ (Empire) Commercial (Indemnity)", "methodology": "case rate", "standard_charge_dollar": 1978.0 }, { "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2268.54, "additional_payer_notes": "100.00% of Medicare Rates" } ] } ] }, { "description": "FEVER AND INFLAMMATORY CONDITIONS", "code_information": [ { "code": "864", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 11815.0, "minimum": 5396.98, "maximum": 21385.874, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "case rate", "standard_charge_dollar": 21385.87, "additional_payer_notes": "181.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medical Rental Network", "methodology": "case rate", "standard_charge_dollar": 21385.87, "additional_payer_notes": "181.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "case rate", "standard_charge_dollar": 9794.16, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "ALLY-ALIGN (FKA SPARTAN PLAN NJ, INC.)", "plan_name": "ALLY-ALIGN (FKA SPARTAN PLAN NJ, INC.)", "methodology": "case rate", "standard_charge_dollar": 12406.17, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Americhoice (UHC)", "plan_name": "UHC Medicare", "methodology": "case rate", "standard_charge_dollar": 9794.16, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Amerihealth", "plan_name": "Amerihealth Medicare", "methodology": "case rate", "standard_charge_dollar": 9794.16, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Commercial", "methodology": "case rate", "standard_charge_dollar": 12987.05 }, { "payer_name": "Clover Health", "plan_name": "Clover Medicare", "methodology": "case rate", "standard_charge_dollar": 9794.16, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Coventry", "plan_name": "Coventry Auto", "methodology": "case rate", "standard_charge_dollar": 20086.18, "additional_payer_notes": "170.00% of Medicare Rates" }, { "payer_name": "Coventry", "plan_name": "Coventry Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 20086.18, "additional_payer_notes": "170.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "case rate", "standard_charge_dollar": 15360.02, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Fairprice Healthcare Holdings", "plan_name": "Fairprice Healthcare Holdings", "methodology": "case rate", "standard_charge_dollar": 18904.64, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon Medicare", "methodology": "case rate", "standard_charge_dollar": 9794.16, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon NJ Health Medicaid", "methodology": "case rate", "standard_charge_dollar": 5396.98 }, { "payer_name": "Humana", "plan_name": "Humana Military Tricare", "methodology": "case rate", "standard_charge_dollar": 9452.32, "additional_payer_notes": "80.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 11815.4, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 8278.45 }, { "payer_name": "UBH", "plan_name": "UBH Medicare", "methodology": "case rate", "standard_charge_dollar": 9794.16, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC All Payer (02-01-2023 to 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 14963.07 }, { "payer_name": "UHC", "plan_name": "UHC Oxford (02-01-2023 to 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 13040.31 }, { "payer_name": "UHC - Adhoc", "plan_name": "UHC - Adhoc All Payer", "methodology": "case rate", "standard_charge_dollar": 15883.62 }, { "payer_name": "UHC - Adhoc", "plan_name": "UHC - Adhoc Oxford", "methodology": "case rate", "standard_charge_dollar": 13438.0 }, { "payer_name": "Wellcare", "plan_name": "Wellcare Insurance Exchange", "methodology": "case rate", "standard_charge_dollar": 15950.79, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "case rate", "standard_charge_dollar": 9794.16, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup Medicare", "methodology": "case rate", "standard_charge_dollar": 9794.16, "additional_payer_notes": "100.00% of Medicare Rates" } ] } ] }, { "description": "Hc Gait Train Therapy Complex, Ea 15 Min", "code_information": [ { "code": "97116", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 147.0, "discounted_cash": 32.0, "minimum": 25.784, "maximum": 147.0, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 68.33, "additional_payer_notes": "212.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medical Rental Network", "methodology": "fee schedule", "standard_charge_dollar": 68.33, "additional_payer_notes": "212.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 32.23, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "ALLY-ALIGN (FKA SPARTAN PLAN NJ, INC.)", "plan_name": "ALLY-ALIGN (FKA SPARTAN PLAN NJ, INC.)", "methodology": "fee schedule", "standard_charge_dollar": 33.84, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Americhoice (UHC)", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 32.23, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Amerihealth", "plan_name": "Amerihealth Medicare", "methodology": "fee schedule", "standard_charge_dollar": 32.23, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 147.0, "additional_payer_notes": "A Indicator - 155.00% of Medicare Rates" }, { "payer_name": "Clover Health", "plan_name": "Clover Medicare", "methodology": "fee schedule", "standard_charge_dollar": 32.23, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Coventry", "plan_name": "Coventry Auto", "methodology": "fee schedule", "standard_charge_dollar": 64.46, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Coventry", "plan_name": "Coventry Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 64.46, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "fee schedule", "standard_charge_dollar": 45.12, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Fairprice Healthcare Holdings", "plan_name": "Fairprice Healthcare Holdings", "methodology": "fee schedule", "standard_charge_dollar": 51.57 }, { "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ HMO POS", "methodology": "fee schedule", "standard_charge_dollar": 103.78, "additional_payer_notes": "177.30% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ Indemnity", "methodology": "fee schedule", "standard_charge_dollar": 103.78, "additional_payer_notes": "177.30% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ PPO", "methodology": "fee schedule", "standard_charge_dollar": 103.78, "additional_payer_notes": "177.30% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon Medicare", "methodology": "fee schedule", "standard_charge_dollar": 32.23, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon NJ Health Medicaid", "methodology": "percent of total billed charges", "standard_charge_percentage": 19.58, "median_amount": 28.78, "10th_percentile": 23.97, "90th_percentile": 56.09, "count": "11" }, { "payer_name": "Humana", "plan_name": "Humana Military Tricare", "methodology": "fee schedule", "standard_charge_dollar": 25.78, "additional_payer_notes": "80.00% of Medicare Rates" }, { "payer_name": "Keenan", "plan_name": "Keenan", "methodology": "percent of total billed charges", "standard_charge_percentage": 30.0, "median_amount": 785.59, "10th_percentile": 522.02, "90th_percentile": 1961.18, "count": "1 through 10" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 32.23, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 32.23, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC All Payer (02-01-2023 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 147.0 }, { "payer_name": "UHC", "plan_name": "UHC Medicaid (02/01/2023 to 12-31-2026)", "methodology": "percent of total billed charges", "standard_charge_percentage": 19.47, "median_amount": 24.28, "10th_percentile": 23.97, "90th_percentile": 32.12, "count": "17" }, { "payer_name": "UHC", "plan_name": "UHC Oxford (02-01-2023 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 147.0 }, { "payer_name": "UHC - Adhoc", "plan_name": "UHC - Adhoc All Payer", "methodology": "fee schedule", "standard_charge_dollar": 147.0 }, { "payer_name": "UHC - Adhoc", "plan_name": "UHC - Adhoc Oxford", "methodology": "fee schedule", "standard_charge_dollar": 147.0 }, { "payer_name": "Wellcare", "plan_name": "Wellcare Insurance Exchange", "methodology": "fee schedule", "standard_charge_dollar": 43.51, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 32.23, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup Medicaid", "methodology": "percent of total billed charges", "standard_charge_percentage": 19.09, "median_amount": 23.97, "10th_percentile": 23.97, "90th_percentile": 32.12, "count": "1 through 10" }, { "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup Medicare", "methodology": "fee schedule", "standard_charge_dollar": 32.23, "additional_payer_notes": "100.00% of Medicare Rates" } ] } ] }, { "description": "Hc Place Needle/Cath, Vein (Midline)", "code_information": [ { "code": "36000", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 36.0, "minimum": 6.8724, "maximum": 13848.0, "payers_information": [ { "payer_name": "UHC", "plan_name": "UHC All Payer (02-01-2023 to 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 36.0 }, { "payer_name": "UHC", "plan_name": "UHC Oxford (02-01-2023 to 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 36.0 }, { "payer_name": "UHC - Adhoc", "plan_name": "UHC - Adhoc All Payer", "methodology": "case rate", "standard_charge_dollar": 36.0 }, { "payer_name": "UHC - Adhoc", "plan_name": "UHC - Adhoc Oxford", "methodology": "case rate", "standard_charge_dollar": 36.0 }, { "payer_name": "Wellchoice", "plan_name": "WELLCHOICE HMO of NJ (Empire) Commercial (HMO / HMO POS, PPO)", "methodology": "case rate", "standard_charge_dollar": 36.0 }, { "payer_name": "Wellchoice", "plan_name": "WELLCHOICE HMO of NJ (Empire) Commercial (Indemnity)", "methodology": "case rate", "standard_charge_dollar": 36.0 }, { "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup Medicaid", "methodology": "percent of total billed charges", "standard_charge_percentage": 19.09, "median_amount": 68.45, "10th_percentile": 68.45, "90th_percentile": 68.45, "count": "1 through 10" } ] } ] }, { "description": "Hc Digital Breast Tomosynthesis Bilat - 77062 - 40100011", "code_information": [ { "code": "77062", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 177.0, "minimum": 33.7893, "maximum": 175.34, "payers_information": [ { "payer_name": "Amerihealth", "plan_name": "Amerihealth HMO", "methodology": "fee schedule", "standard_charge_dollar": 111.23 }, { "payer_name": "Keenan", "plan_name": "Keenan", "methodology": "percent of total billed charges", "standard_charge_percentage": 30.0, "median_amount": 53.1, "10th_percentile": 53.1, "90th_percentile": 53.1, "count": "1 through 10" }, { "payer_name": "UHC", "plan_name": "UHC All Payer (02-01-2023 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 175.34 }, { "payer_name": "UHC", "plan_name": "UHC Medicaid (02/01/2023 to 12-31-2026)", "methodology": "percent of total billed charges", "standard_charge_percentage": 19.47, "median_amount": 33.67, "10th_percentile": 33.67, "90th_percentile": 34.47, "count": "1 through 10" }, { "payer_name": "UHC", "plan_name": "UHC Oxford (02-01-2023 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 175.34 }, { "payer_name": "UHC - Adhoc", "plan_name": "UHC - Adhoc All Payer", "methodology": "fee schedule", "standard_charge_dollar": 116.89 }, { "payer_name": "UHC - Adhoc", "plan_name": "UHC - Adhoc Oxford", "methodology": "fee schedule", "standard_charge_dollar": 116.89 }, { "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup Medicaid", "methodology": "percent of total billed charges", "standard_charge_percentage": 19.09, "median_amount": 33.01, "10th_percentile": 33.01, "90th_percentile": 33.01, "count": "1 through 10" } ] } ] }, { "description": "Hc Blood Platelet Aggregation", "code_information": [ { "code": "85576", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 88.43, "discounted_cash": 24.0, "minimum": 14.95, "maximum": 75.1655, "payers_information": [ { "payer_name": "ALLY-ALIGN (FKA SPARTAN PLAN NJ, INC.)", "plan_name": "ALLY-ALIGN (FKA SPARTAN PLAN NJ, INC.)", "methodology": "fee schedule", "standard_charge_dollar": 26.16, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Americhoice (UHC)", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 24.91, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Amerihealth", "plan_name": "Amerihealth Medicare", "methodology": "fee schedule", "standard_charge_dollar": 24.91, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 36.12, "additional_payer_notes": "Laboratory - 145.00% of Medicare Rates" }, { "payer_name": "Clover Health", "plan_name": "Clover Medicare", "methodology": "fee schedule", "standard_charge_dollar": 24.91, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Coventry", "plan_name": "Coventry Auto", "methodology": "fee schedule", "standard_charge_dollar": 49.82, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Coventry", "plan_name": "Coventry Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 49.82, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "fee schedule", "standard_charge_dollar": 34.87, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Fairprice Healthcare Holdings", "plan_name": "Fairprice Healthcare Holdings", "methodology": "fee schedule", "standard_charge_dollar": 29.89, "additional_payer_notes": "Laboratory - 120.00% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ HMO POS", "methodology": "fee schedule", "standard_charge_dollar": 62.43, "additional_payer_notes": "177.30% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ Indemnity", "methodology": "fee schedule", "standard_charge_dollar": 62.43, "additional_payer_notes": "177.30% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ PPO", "methodology": "fee schedule", "standard_charge_dollar": 62.43, "additional_payer_notes": "177.30% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon Medicare", "methodology": "fee schedule", "standard_charge_dollar": 24.91, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Military Tricare", "methodology": "fee schedule", "standard_charge_dollar": 19.93, "additional_payer_notes": "80.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 24.91, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 24.91, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC All Payer (02-01-2023 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 14.95 }, { "payer_name": "UHC", "plan_name": "UHC Medicaid (02/01/2023 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 19.93 }, { "payer_name": "UHC", "plan_name": "UHC Oxford (02-01-2023 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 14.95 }, { "payer_name": "UHC - Adhoc", "plan_name": "UHC - Adhoc All Payer", "methodology": "fee schedule", "standard_charge_dollar": 24.91 }, { "payer_name": "UHC - Adhoc", "plan_name": "UHC - Adhoc Oxford", "methodology": "fee schedule", "standard_charge_dollar": 24.91 }, { "payer_name": "Wellcare", "plan_name": "Wellcare Insurance Exchange", "methodology": "fee schedule", "standard_charge_dollar": 33.63, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 24.91, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup Medicare", "methodology": "fee schedule", "standard_charge_dollar": 24.91, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 52.81, "additional_payer_notes": "212.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medical Rental Network", "methodology": "fee schedule", "standard_charge_dollar": 52.81, "additional_payer_notes": "212.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 24.91, "additional_payer_notes": "100.00% of Medicare Rates" } ] } ] }, { "description": "CORONARY INTRAVASCULAR LITHOTRIPSY WITHOUT INTRALUMINAL DEVICE", "code_information": [ { "code": "325", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 38657.0, "minimum": 30926.088, "maximum": 69970.2741, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "case rate", "standard_charge_dollar": 69970.27, "additional_payer_notes": "181.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medical Rental Network", "methodology": "case rate", "standard_charge_dollar": 69970.27, "additional_payer_notes": "181.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "case rate", "standard_charge_dollar": 31347.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "ALLY-ALIGN (FKA SPARTAN PLAN NJ, INC.)", "plan_name": "ALLY-ALIGN (FKA SPARTAN PLAN NJ, INC.)", "methodology": "case rate", "standard_charge_dollar": 40590.49, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Americhoice (UHC)", "plan_name": "UHC Medicare", "methodology": "case rate", "standard_charge_dollar": 31347.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Amerihealth", "plan_name": "Amerihealth Medicare", "methodology": "case rate", "standard_charge_dollar": 31347.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Commercial", "methodology": "case rate", "standard_charge_dollar": 46968.15 }, { "payer_name": "Clover Health", "plan_name": "Clover Medicare", "methodology": "case rate", "standard_charge_dollar": 31347.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Coventry", "plan_name": "Coventry Auto", "methodology": "case rate", "standard_charge_dollar": 65717.94, "additional_payer_notes": "170.00% of Medicare Rates" }, { "payer_name": "Coventry", "plan_name": "Coventry Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 65717.94, "additional_payer_notes": "170.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "case rate", "standard_charge_dollar": 50254.89, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Fairprice Healthcare Holdings", "plan_name": "Fairprice Healthcare Holdings", "methodology": "case rate", "standard_charge_dollar": 61852.18, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon Medicare", "methodology": "case rate", "standard_charge_dollar": 31347.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Military Tricare", "methodology": "case rate", "standard_charge_dollar": 30926.09, "additional_payer_notes": "80.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 38657.61, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 41640.0 }, { "payer_name": "UBH", "plan_name": "UBH Medicare", "methodology": "case rate", "standard_charge_dollar": 31347.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC All Payer (02-01-2023 to 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 54114.5 }, { "payer_name": "UHC", "plan_name": "UHC Oxford (02-01-2023 to 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 47160.78 }, { "payer_name": "UHC - Adhoc", "plan_name": "UHC - Adhoc All Payer", "methodology": "case rate", "standard_charge_dollar": 57443.69 }, { "payer_name": "UHC - Adhoc", "plan_name": "UHC - Adhoc Oxford", "methodology": "case rate", "standard_charge_dollar": 48599.04 }, { "payer_name": "Wellcare", "plan_name": "Wellcare Insurance Exchange", "methodology": "case rate", "standard_charge_dollar": 52187.77, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "case rate", "standard_charge_dollar": 31347.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup Medicare", "methodology": "case rate", "standard_charge_dollar": 31347.7, "additional_payer_notes": "100.00% of Medicare Rates" } ] } ] }, { "description": "Hc Mri Brain", "code_information": [ { "code": "70551", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 3241.69, "discounted_cash": 282.0, "minimum": 225.656, "maximum": 2755.4365, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 597.99, "additional_payer_notes": "212.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medical Rental Network", "methodology": "fee schedule", "standard_charge_dollar": 597.99, "additional_payer_notes": "212.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 282.07, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "ALLY-ALIGN (FKA SPARTAN PLAN NJ, INC.)", "plan_name": "ALLY-ALIGN (FKA SPARTAN PLAN NJ, INC.)", "methodology": "fee schedule", "standard_charge_dollar": 296.17, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Americhoice (UHC)", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 282.07, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Amerihealth", "plan_name": "Amerihealth HMO", "methodology": "fee schedule", "standard_charge_dollar": 765.7 }, { "payer_name": "Amerihealth", "plan_name": "Amerihealth Medicare", "methodology": "fee schedule", "standard_charge_dollar": 282.07, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 414.5, "additional_payer_notes": "146.95% of Medicare Rates" }, { "payer_name": "Clover Health", "plan_name": "Clover Medicare", "methodology": "fee schedule", "standard_charge_dollar": 282.07, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Coventry", "plan_name": "Coventry Auto", "methodology": "fee schedule", "standard_charge_dollar": 564.14, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Coventry", "plan_name": "Coventry Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 564.14, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "fee schedule", "standard_charge_dollar": 394.9, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Fairprice Healthcare Holdings", "plan_name": "Fairprice Healthcare Holdings", "methodology": "fee schedule", "standard_charge_dollar": 451.31, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ HMO POS", "methodology": "fee schedule", "standard_charge_dollar": 500.11, "additional_payer_notes": "177.30% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ Indemnity", "methodology": "fee schedule", "standard_charge_dollar": 500.11, "additional_payer_notes": "177.30% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ PPO", "methodology": "fee schedule", "standard_charge_dollar": 500.11, "additional_payer_notes": "177.30% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon Medicare", "methodology": "fee schedule", "standard_charge_dollar": 282.07, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon NJ Health Medicaid", "methodology": "percent of total billed charges", "standard_charge_percentage": 19.58, "median_amount": 634.72, "10th_percentile": 284.66, "90th_percentile": 634.72, "count": "1 through 10" }, { "payer_name": "Humana", "plan_name": "Humana Military Tricare", "methodology": "fee schedule", "standard_charge_dollar": 225.66, "additional_payer_notes": "80.00% of Medicare Rates" }, { "payer_name": "Keenan", "plan_name": "Keenan", "methodology": "percent of total billed charges", "standard_charge_percentage": 30.0, "median_amount": 972.51, "10th_percentile": 972.51, "90th_percentile": 2053.73, "count": "1 through 10" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 282.07, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 282.07, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC All Payer (02-01-2023 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 345.2 }, { "payer_name": "UHC", "plan_name": "UHC Medicaid (02/01/2023 to 12-31-2026)", "methodology": "percent of total billed charges", "standard_charge_percentage": 19.47, "median_amount": 616.67, "10th_percentile": 616.67, "90th_percentile": 622.37, "count": "1 through 10" }, { "payer_name": "UHC", "plan_name": "UHC Oxford (02-01-2023 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 345.2 }, { "payer_name": "UHC - Adhoc", "plan_name": "UHC - Adhoc All Payer", "methodology": "fee schedule", "standard_charge_dollar": 230.13 }, { "payer_name": "UHC - Adhoc", "plan_name": "UHC - Adhoc Oxford", "methodology": "fee schedule", "standard_charge_dollar": 230.13 }, { "payer_name": "Wellcare", "plan_name": "Wellcare Insurance Exchange", "methodology": "fee schedule", "standard_charge_dollar": 380.79, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 282.07, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup Medicare", "methodology": "fee schedule", "standard_charge_dollar": 282.07, "additional_payer_notes": "100.00% of Medicare Rates" } ] } ] }, { "description": "Hc Unlisted Modality", "code_information": [ { "code": "97039", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 119.0, "minimum": 22.7171, "maximum": 119.0, "payers_information": [ { "payer_name": "UHC", "plan_name": "UHC All Payer (02-01-2023 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 119.0 }, { "payer_name": "UHC", "plan_name": "UHC Oxford (02-01-2023 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 119.0 }, { "payer_name": "UHC - Adhoc", "plan_name": "UHC - Adhoc All Payer", "methodology": "fee schedule", "standard_charge_dollar": 119.0 }, { "payer_name": "UHC - Adhoc", "plan_name": "UHC - Adhoc Oxford", "methodology": "fee schedule", "standard_charge_dollar": 119.0 } ] } ] }, { "description": "Hc X-Ray Thoracic Spine 2 Vw", "code_information": [ { "code": "72070", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 562.55, "discounted_cash": 123.0, "minimum": 58.03, "maximum": 478.1675, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 262.01, "additional_payer_notes": "212.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medical Rental Network", "methodology": "fee schedule", "standard_charge_dollar": 262.01, "additional_payer_notes": "212.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 123.59, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "ALLY-ALIGN (FKA SPARTAN PLAN NJ, INC.)", "plan_name": "ALLY-ALIGN (FKA SPARTAN PLAN NJ, INC.)", "methodology": "fee schedule", "standard_charge_dollar": 129.77, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Americhoice (UHC)", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 123.59, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Amerihealth", "plan_name": "Amerihealth HMO", "methodology": "fee schedule", "standard_charge_dollar": 58.03 }, { "payer_name": "Amerihealth", "plan_name": "Amerihealth Medicare", "methodology": "fee schedule", "standard_charge_dollar": 123.59, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 181.62, "additional_payer_notes": "146.95% of Medicare Rates" }, { "payer_name": "Clover Health", "plan_name": "Clover Medicare", "methodology": "fee schedule", "standard_charge_dollar": 123.59, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Coventry", "plan_name": "Coventry Auto", "methodology": "fee schedule", "standard_charge_dollar": 247.18, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Coventry", "plan_name": "Coventry Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 247.18, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "fee schedule", "standard_charge_dollar": 173.03, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Fairprice Healthcare Holdings", "plan_name": "Fairprice Healthcare Holdings", "methodology": "fee schedule", "standard_charge_dollar": 197.74, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ HMO POS", "methodology": "fee schedule", "standard_charge_dollar": 219.13, "additional_payer_notes": "177.30% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ Indemnity", "methodology": "fee schedule", "standard_charge_dollar": 219.13, "additional_payer_notes": "177.30% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ PPO", "methodology": "fee schedule", "standard_charge_dollar": 219.13, "additional_payer_notes": "177.30% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon Medicare", "methodology": "fee schedule", "standard_charge_dollar": 123.59, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon NJ Health Medicaid", "methodology": "percent of total billed charges", "standard_charge_percentage": 19.58, "median_amount": 110.15, "10th_percentile": 110.15, "90th_percentile": 110.15, "count": "12" }, { "payer_name": "Humana", "plan_name": "Humana Military Tricare", "methodology": "fee schedule", "standard_charge_dollar": 98.87, "additional_payer_notes": "80.00% of Medicare Rates" }, { "payer_name": "Keenan", "plan_name": "Keenan", "methodology": "percent of total billed charges", "standard_charge_percentage": 30.0, "median_amount": 340.37, "10th_percentile": 340.37, "90th_percentile": 340.37, "count": "1 through 10" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 123.59, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 123.59, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC All Payer (02-01-2023 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 163.46 }, { "payer_name": "UHC", "plan_name": "UHC Medicaid (02/01/2023 to 12-31-2026)", "methodology": "percent of total billed charges", "standard_charge_percentage": 19.47, "median_amount": 107.02, "10th_percentile": 107.02, "90th_percentile": 107.02, "count": "1 through 10" }, { "payer_name": "UHC", "plan_name": "UHC Oxford (02-01-2023 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 163.46 }, { "payer_name": "UHC - Adhoc", "plan_name": "UHC - Adhoc All Payer", "methodology": "fee schedule", "standard_charge_dollar": 108.97 }, { "payer_name": "UHC - Adhoc", "plan_name": "UHC - Adhoc Oxford", "methodology": "fee schedule", "standard_charge_dollar": 108.97 }, { "payer_name": "Wellcare", "plan_name": "Wellcare Insurance Exchange", "methodology": "fee schedule", "standard_charge_dollar": 166.85, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 123.59, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup Medicaid", "methodology": "percent of total billed charges", "standard_charge_percentage": 19.09, "median_amount": 104.92, "10th_percentile": 104.92, "90th_percentile": 107.39, "count": "1 through 10" }, { "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup Medicare", "methodology": "fee schedule", "standard_charge_dollar": 123.59, "additional_payer_notes": "100.00% of Medicare Rates" } ] } ] }, { "description": "Hc Pet Imaging For Ct Attenuation Whole Body", "code_information": [ { "code": "78816", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 6915.59, "discounted_cash": 1690.0, "minimum": 1320.1861, "maximum": 5878.2515, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 3583.84, "additional_payer_notes": "212.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medical Rental Network", "methodology": "fee schedule", "standard_charge_dollar": 3583.84, "additional_payer_notes": "212.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1690.49, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "ALLY-ALIGN (FKA SPARTAN PLAN NJ, INC.)", "plan_name": "ALLY-ALIGN (FKA SPARTAN PLAN NJ, INC.)", "methodology": "fee schedule", "standard_charge_dollar": 1775.01, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Americhoice (UHC)", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1690.49, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Amerihealth", "plan_name": "Amerihealth HMO", "methodology": "fee schedule", "standard_charge_dollar": 2859.69 }, { "payer_name": "Amerihealth", "plan_name": "Amerihealth Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1690.49, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 2484.18, "additional_payer_notes": "146.95% of Medicare Rates" }, { "payer_name": "Clover Health", "plan_name": "Clover Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1690.49, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Coventry", "plan_name": "Coventry Auto", "methodology": "fee schedule", "standard_charge_dollar": 3380.98, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Coventry", "plan_name": "Coventry Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 3380.98, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "fee schedule", "standard_charge_dollar": 2366.69, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Fairprice Healthcare Holdings", "plan_name": "Fairprice Healthcare Holdings", "methodology": "fee schedule", "standard_charge_dollar": 2704.78, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ HMO POS", "methodology": "fee schedule", "standard_charge_dollar": 2997.24, "additional_payer_notes": "177.30% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ Indemnity", "methodology": "fee schedule", "standard_charge_dollar": 2997.24, "additional_payer_notes": "177.30% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ PPO", "methodology": "fee schedule", "standard_charge_dollar": 2997.24, "additional_payer_notes": "177.30% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1690.49, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Military Tricare", "methodology": "fee schedule", "standard_charge_dollar": 1352.39, "additional_payer_notes": "80.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1690.49, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 1690.49, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC All Payer (02-01-2023 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 2220.51 }, { "payer_name": "UHC", "plan_name": "UHC Oxford (02-01-2023 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 2220.51 }, { "payer_name": "UHC - Adhoc", "plan_name": "UHC - Adhoc All Payer", "methodology": "fee schedule", "standard_charge_dollar": 1480.34 }, { "payer_name": "UHC - Adhoc", "plan_name": "UHC - Adhoc Oxford", "methodology": "fee schedule", "standard_charge_dollar": 1480.34 }, { "payer_name": "Wellcare", "plan_name": "Wellcare Insurance Exchange", "methodology": "fee schedule", "standard_charge_dollar": 2282.16, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1690.49, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1690.49, "additional_payer_notes": "100.00% of Medicare Rates" } ] } ] }, { "description": "HIP REPLACEMENT WITH PRINCIPAL DIAGNOSIS OF HIP FRACTURE WITH MCC", "code_information": [ { "code": "521", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 34726.0, "minimum": 27780.88, "maximum": 62854.241, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "case rate", "standard_charge_dollar": 62854.24, "additional_payer_notes": "181.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medical Rental Network", "methodology": "case rate", "standard_charge_dollar": 62854.24, "additional_payer_notes": "181.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "case rate", "standard_charge_dollar": 28190.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "ALLY-ALIGN (FKA SPARTAN PLAN NJ, INC.)", "plan_name": "ALLY-ALIGN (FKA SPARTAN PLAN NJ, INC.)", "methodology": "case rate", "standard_charge_dollar": 36462.41, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Americhoice (UHC)", "plan_name": "UHC Medicare", "methodology": "case rate", "standard_charge_dollar": 28190.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Amerihealth", "plan_name": "Amerihealth Medicare", "methodology": "case rate", "standard_charge_dollar": 28190.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Commercial", "methodology": "case rate", "standard_charge_dollar": 41991.03 }, { "payer_name": "Clover Health", "plan_name": "Clover Medicare", "methodology": "case rate", "standard_charge_dollar": 28190.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Coventry", "plan_name": "Coventry Auto", "methodology": "case rate", "standard_charge_dollar": 59034.37, "additional_payer_notes": "170.00% of Medicare Rates" }, { "payer_name": "Coventry", "plan_name": "Coventry Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 59034.37, "additional_payer_notes": "170.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "case rate", "standard_charge_dollar": 45143.93, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Fairprice Healthcare Holdings", "plan_name": "Fairprice Healthcare Holdings", "methodology": "case rate", "standard_charge_dollar": 55561.76, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon Medicare", "methodology": "case rate", "standard_charge_dollar": 28190.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Military Tricare", "methodology": "case rate", "standard_charge_dollar": 27780.88, "additional_payer_notes": "80.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 34726.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 42405.4 }, { "payer_name": "UBH", "plan_name": "UBH Medicare", "methodology": "case rate", "standard_charge_dollar": 28190.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC All Payer (02-01-2023 to 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 48380.09 }, { "payer_name": "UHC", "plan_name": "UHC Oxford (02-01-2023 to 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 42163.24 }, { "payer_name": "UHC - Adhoc", "plan_name": "UHC - Adhoc All Payer", "methodology": "case rate", "standard_charge_dollar": 51356.49 }, { "payer_name": "UHC - Adhoc", "plan_name": "UHC - Adhoc Oxford", "methodology": "case rate", "standard_charge_dollar": 43449.09 }, { "payer_name": "Wellcare", "plan_name": "Wellcare Insurance Exchange", "methodology": "case rate", "standard_charge_dollar": 46880.24, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "case rate", "standard_charge_dollar": 28190.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup Medicare", "methodology": "case rate", "standard_charge_dollar": 28190.8, "additional_payer_notes": "100.00% of Medicare Rates" } ] } ] }, { "description": "Hc Cytogenetics, 10-30", "code_information": [ { "code": "88273", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 163.0, "discounted_cash": 34.0, "minimum": 20.89, "maximum": 138.55, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 73.8, "additional_payer_notes": "212.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medical Rental Network", "methodology": "fee schedule", "standard_charge_dollar": 73.8, "additional_payer_notes": "212.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 34.81, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "ALLY-ALIGN (FKA SPARTAN PLAN NJ, INC.)", "plan_name": "ALLY-ALIGN (FKA SPARTAN PLAN NJ, INC.)", "methodology": "fee schedule", "standard_charge_dollar": 36.55, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Americhoice (UHC)", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 34.81, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Amerihealth", "plan_name": "Amerihealth Medicare", "methodology": "fee schedule", "standard_charge_dollar": 34.81, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 50.47, "additional_payer_notes": "Laboratory - 145.00% of Medicare Rates" }, { "payer_name": "Clover Health", "plan_name": "Clover Medicare", "methodology": "fee schedule", "standard_charge_dollar": 34.81, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Coventry", "plan_name": "Coventry Auto", "methodology": "fee schedule", "standard_charge_dollar": 69.62, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Coventry", "plan_name": "Coventry Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 69.62, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "fee schedule", "standard_charge_dollar": 48.73, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Fairprice Healthcare Holdings", "plan_name": "Fairprice Healthcare Holdings", "methodology": "fee schedule", "standard_charge_dollar": 41.77, "additional_payer_notes": "Laboratory - 120.00% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ HMO POS", "methodology": "fee schedule", "standard_charge_dollar": 115.08, "additional_payer_notes": "177.30% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ Indemnity", "methodology": "fee schedule", "standard_charge_dollar": 115.08, "additional_payer_notes": "177.30% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ PPO", "methodology": "fee schedule", "standard_charge_dollar": 115.08, "additional_payer_notes": "177.30% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon Medicare", "methodology": "fee schedule", "standard_charge_dollar": 34.81, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon NJ Health Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 27.85 }, { "payer_name": "Humana", "plan_name": "Humana Military Tricare", "methodology": "fee schedule", "standard_charge_dollar": 27.85, "additional_payer_notes": "80.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 34.81, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 34.81, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC All Payer (02-01-2023 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 20.89 }, { "payer_name": "UHC", "plan_name": "UHC Medicaid (02/01/2023 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 27.85 }, { "payer_name": "UHC", "plan_name": "UHC Oxford (02-01-2023 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 20.89 }, { "payer_name": "UHC - Adhoc", "plan_name": "UHC - Adhoc All Payer", "methodology": "fee schedule", "standard_charge_dollar": 34.81 }, { "payer_name": "UHC - Adhoc", "plan_name": "UHC - Adhoc Oxford", "methodology": "fee schedule", "standard_charge_dollar": 34.81 }, { "payer_name": "Wellcare", "plan_name": "Wellcare Insurance Exchange", "methodology": "fee schedule", "standard_charge_dollar": 46.99, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 34.81, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup Medicare", "methodology": "fee schedule", "standard_charge_dollar": 34.81, "additional_payer_notes": "100.00% of Medicare Rates" } ] } ] }, { "description": "Hc Needle Biopsy Liver", "code_information": [ { "code": "47000", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 6655.86, "discounted_cash": 1952.0, "minimum": 1270.6037, "maximum": 5324.688, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 4139.36, "additional_payer_notes": "212.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medical Rental Network", "methodology": "fee schedule", "standard_charge_dollar": 4139.36, "additional_payer_notes": "212.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1952.53, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "ALLY-ALIGN (FKA SPARTAN PLAN NJ, INC.)", "plan_name": "ALLY-ALIGN (FKA SPARTAN PLAN NJ, INC.)", "methodology": "fee schedule", "standard_charge_dollar": 2050.16, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Americhoice (UHC)", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1952.53, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Amerihealth", "plan_name": "Amerihealth Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1952.53, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 2869.24, "additional_payer_notes": "146.95% of Medicare Rates" }, { "payer_name": "Clover Health", "plan_name": "Clover Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1952.53, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Coventry", "plan_name": "Coventry Auto", "methodology": "fee schedule", "standard_charge_dollar": 3905.06, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Coventry", "plan_name": "Coventry Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 3905.06, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "fee schedule", "standard_charge_dollar": 2733.54, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Fairprice Healthcare Holdings", "plan_name": "Fairprice Healthcare Holdings", "methodology": "fee schedule", "standard_charge_dollar": 3124.05, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ HMO POS", "methodology": "fee schedule", "standard_charge_dollar": 3461.84, "additional_payer_notes": "177.30% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ Indemnity", "methodology": "fee schedule", "standard_charge_dollar": 3461.84, "additional_payer_notes": "177.30% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ PPO", "methodology": "fee schedule", "standard_charge_dollar": 3461.84, "additional_payer_notes": "177.30% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1952.53, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Military Tricare", "methodology": "fee schedule", "standard_charge_dollar": 1562.02, "additional_payer_notes": "80.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1952.53, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 1952.53, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC All Payer (02-01-2023 to 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 3912.0 }, { "payer_name": "UHC", "plan_name": "UHC Oxford (02-01-2023 to 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 3676.0 }, { "payer_name": "UHC - Adhoc", "plan_name": "UHC - Adhoc All Payer", "methodology": "case rate", "standard_charge_dollar": 4153.0 }, { "payer_name": "UHC - Adhoc", "plan_name": "UHC - Adhoc Oxford", "methodology": "case rate", "standard_charge_dollar": 3788.0 }, { "payer_name": "Wellcare", "plan_name": "Wellcare Insurance Exchange", "methodology": "fee schedule", "standard_charge_dollar": 2635.92, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1952.53, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellchoice", "plan_name": "WELLCHOICE HMO of NJ (Empire) Commercial (HMO / HMO POS, PPO)", "methodology": "case rate", "standard_charge_dollar": 1715.0 }, { "payer_name": "Wellchoice", "plan_name": "WELLCHOICE HMO of NJ (Empire) Commercial (Indemnity)", "methodology": "case rate", "standard_charge_dollar": 1978.0 }, { "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1952.53, "additional_payer_notes": "100.00% of Medicare Rates" } ] } ] }, { "description": "OTHER PNEUMONIA - SOI : 3", "code_information": [ { "code": "1393", "type": "APR-DRG" } ], "standard_charges": [ { "setting": "inpatient", "minimum": 11161.68, "maximum": 12277.85, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Better Health - Medi Medi", "methodology": "case rate", "standard_charge_dollar": 12277.85, "additional_payer_notes": "110% of State Medicaid Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Better Health Medicaid", "methodology": "case rate", "standard_charge_dollar": 12277.85, "additional_payer_notes": "110% of State Medicaid Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "case rate", "standard_charge_dollar": 11161.68, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "UBH", "plan_name": "UBH Medicaid", "methodology": "case rate", "standard_charge_dollar": 11161.68, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicaid (02/01/2023 to 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 11384.91, "additional_payer_notes": "102% of State Medicaid Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicaid", "methodology": "case rate", "standard_charge_dollar": 11161.68, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup Medicaid", "methodology": "case rate", "standard_charge_dollar": 11161.68, "additional_payer_notes": "100% of State Medicaid Rates" } ] } ] }, { "description": "KNEE & LOWER LEG PROCEDURES EXCEPT FOOT - SOI : 4", "code_information": [ { "code": "3134", "type": "APR-DRG" } ], "standard_charges": [ { "setting": "inpatient", "minimum": 50132.92, "maximum": 55146.21, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Better Health - Medi Medi", "methodology": "case rate", "standard_charge_dollar": 55146.21, "additional_payer_notes": "110% of State Medicaid Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Better Health Medicaid", "methodology": "case rate", "standard_charge_dollar": 55146.21, "additional_payer_notes": "110% of State Medicaid Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "case rate", "standard_charge_dollar": 50132.92, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "UBH", "plan_name": "UBH Medicaid", "methodology": "case rate", "standard_charge_dollar": 50132.92, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicaid (02/01/2023 to 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 51135.58, "additional_payer_notes": "102% of State Medicaid Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicaid", "methodology": "case rate", "standard_charge_dollar": 50132.92, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup Medicaid", "methodology": "case rate", "standard_charge_dollar": 50132.92, "additional_payer_notes": "100% of State Medicaid Rates" } ] } ] }, { "description": "DISORDERS OF PANCREAS EXCEPT MALIGNANCY WITH CC", "code_information": [ { "code": "439", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 11278.0, "minimum": 5384.49, "maximum": 20413.2162, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "case rate", "standard_charge_dollar": 20413.22, "additional_payer_notes": "181.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medical Rental Network", "methodology": "case rate", "standard_charge_dollar": 20413.22, "additional_payer_notes": "181.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "case rate", "standard_charge_dollar": 9362.66, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "ALLY-ALIGN (FKA SPARTAN PLAN NJ, INC.)", "plan_name": "ALLY-ALIGN (FKA SPARTAN PLAN NJ, INC.)", "methodology": "case rate", "standard_charge_dollar": 11841.92, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Americhoice (UHC)", "plan_name": "UHC Medicare", "methodology": "case rate", "standard_charge_dollar": 9362.66, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Amerihealth", "plan_name": "Amerihealth Medicare", "methodology": "case rate", "standard_charge_dollar": 9362.66, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Commercial", "methodology": "case rate", "standard_charge_dollar": 12306.76 }, { "payer_name": "Clover Health", "plan_name": "Clover Medicare", "methodology": "case rate", "standard_charge_dollar": 9362.66, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Coventry", "plan_name": "Coventry Auto", "methodology": "case rate", "standard_charge_dollar": 19172.63, "additional_payer_notes": "170.00% of Medicare Rates" }, { "payer_name": "Coventry", "plan_name": "Coventry Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 19172.63, "additional_payer_notes": "170.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "case rate", "standard_charge_dollar": 14661.43, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Fairprice Healthcare Holdings", "plan_name": "Fairprice Healthcare Holdings", "methodology": "case rate", "standard_charge_dollar": 18044.83, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon Medicare", "methodology": "case rate", "standard_charge_dollar": 9362.66, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon NJ Health Medicaid", "methodology": "case rate", "standard_charge_dollar": 5384.49 }, { "payer_name": "Humana", "plan_name": "Humana Military Tricare", "methodology": "case rate", "standard_charge_dollar": 9022.42, "additional_payer_notes": "80.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 11278.02, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 9988.93 }, { "payer_name": "UBH", "plan_name": "UBH Medicare", "methodology": "case rate", "standard_charge_dollar": 9362.66, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC All Payer (02-01-2023 to 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 14179.27 }, { "payer_name": "UHC", "plan_name": "UHC Oxford (02-01-2023 to 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 12357.23 }, { "payer_name": "UHC - Adhoc", "plan_name": "UHC - Adhoc All Payer", "methodology": "case rate", "standard_charge_dollar": 15051.59 }, { "payer_name": "UHC - Adhoc", "plan_name": "UHC - Adhoc Oxford", "methodology": "case rate", "standard_charge_dollar": 12734.09 }, { "payer_name": "Wellcare", "plan_name": "Wellcare Insurance Exchange", "methodology": "case rate", "standard_charge_dollar": 15225.33, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "case rate", "standard_charge_dollar": 9362.66, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup Medicare", "methodology": "case rate", "standard_charge_dollar": 9362.66, "additional_payer_notes": "100.00% of Medicare Rates" } ] } ] }, { "description": "INTRACRANIAL HEMORRHAGE OR CEREBRAL INFARCTION WITH CC OR TPA IN 24 HOURS", "code_information": [ { "code": "065", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 13232.0, "minimum": 6441.03, "maximum": 23950.3182, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "case rate", "standard_charge_dollar": 23950.32, "additional_payer_notes": "181.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medical Rental Network", "methodology": "case rate", "standard_charge_dollar": 23950.32, "additional_payer_notes": "181.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "case rate", "standard_charge_dollar": 10931.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "ALLY-ALIGN (FKA SPARTAN PLAN NJ, INC.)", "plan_name": "ALLY-ALIGN (FKA SPARTAN PLAN NJ, INC.)", "methodology": "case rate", "standard_charge_dollar": 13893.83, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Americhoice (UHC)", "plan_name": "UHC Medicare", "methodology": "case rate", "standard_charge_dollar": 10931.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Amerihealth", "plan_name": "Amerihealth Medicare", "methodology": "case rate", "standard_charge_dollar": 10931.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Commercial", "methodology": "case rate", "standard_charge_dollar": 14780.69 }, { "payer_name": "Clover Health", "plan_name": "Clover Medicare", "methodology": "case rate", "standard_charge_dollar": 10931.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Coventry", "plan_name": "Coventry Auto", "methodology": "case rate", "standard_charge_dollar": 22494.77, "additional_payer_notes": "170.00% of Medicare Rates" }, { "payer_name": "Coventry", "plan_name": "Coventry Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 22494.77, "additional_payer_notes": "170.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "case rate", "standard_charge_dollar": 17201.89, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Fairprice Healthcare Holdings", "plan_name": "Fairprice Healthcare Holdings", "methodology": "case rate", "standard_charge_dollar": 21171.55, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon Medicare", "methodology": "case rate", "standard_charge_dollar": 10931.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon NJ Health Medicaid", "methodology": "case rate", "standard_charge_dollar": 6441.03 }, { "payer_name": "Humana", "plan_name": "Humana Military Tricare", "methodology": "case rate", "standard_charge_dollar": 10585.78, "additional_payer_notes": "80.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 13232.22, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 14154.4 }, { "payer_name": "UBH", "plan_name": "UBH Medicare", "methodology": "case rate", "standard_charge_dollar": 10931.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC All Payer (02-01-2023 to 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 17029.62 }, { "payer_name": "UHC", "plan_name": "UHC Oxford (02-01-2023 to 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 14841.31 }, { "payer_name": "UHC - Adhoc", "plan_name": "UHC - Adhoc All Payer", "methodology": "case rate", "standard_charge_dollar": 18077.3 }, { "payer_name": "UHC - Adhoc", "plan_name": "UHC - Adhoc Oxford", "methodology": "case rate", "standard_charge_dollar": 15293.92 }, { "payer_name": "Wellcare", "plan_name": "Wellcare Insurance Exchange", "methodology": "case rate", "standard_charge_dollar": 17863.5, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "case rate", "standard_charge_dollar": 10931.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup Medicare", "methodology": "case rate", "standard_charge_dollar": 10931.8, "additional_payer_notes": "100.00% of Medicare Rates" } ] } ] }, { "description": "ELECTIVE HIP JOINT REPLACEMENT- SOI : 4", "code_information": [ { "code": "3244", "type": "APR-DRG" } ], "standard_charges": [ { "setting": "inpatient", "minimum": 44019.12, "maximum": 48421.03, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Better Health - Medi Medi", "methodology": "case rate", "standard_charge_dollar": 48421.03, "additional_payer_notes": "110% of State Medicaid Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Better Health Medicaid", "methodology": "case rate", "standard_charge_dollar": 48421.03, "additional_payer_notes": "110% of State Medicaid Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "case rate", "standard_charge_dollar": 44019.12, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "UBH", "plan_name": "UBH Medicaid", "methodology": "case rate", "standard_charge_dollar": 44019.12, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicaid (02/01/2023 to 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 44899.5, "additional_payer_notes": "102% of State Medicaid Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicaid", "methodology": "case rate", "standard_charge_dollar": 44019.12, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup Medicaid", "methodology": "case rate", "standard_charge_dollar": 44019.12, "additional_payer_notes": "100% of State Medicaid Rates" } ] } ] }, { "description": "PLEURAL EFFUSION WITH CC", "code_information": [ { "code": "187", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 12987.0, "minimum": 6581.53, "maximum": 23506.8682, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "case rate", "standard_charge_dollar": 23506.87, "additional_payer_notes": "181.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medical Rental Network", "methodology": "case rate", "standard_charge_dollar": 23506.87, "additional_payer_notes": "181.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "case rate", "standard_charge_dollar": 10735.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "ALLY-ALIGN (FKA SPARTAN PLAN NJ, INC.)", "plan_name": "ALLY-ALIGN (FKA SPARTAN PLAN NJ, INC.)", "methodology": "case rate", "standard_charge_dollar": 13636.58, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Americhoice (UHC)", "plan_name": "UHC Medicare", "methodology": "case rate", "standard_charge_dollar": 10735.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Amerihealth", "plan_name": "Amerihealth Medicare", "methodology": "case rate", "standard_charge_dollar": 10735.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Commercial", "methodology": "case rate", "standard_charge_dollar": 14470.53 }, { "payer_name": "Clover Health", "plan_name": "Clover Medicare", "methodology": "case rate", "standard_charge_dollar": 10735.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Coventry", "plan_name": "Coventry Auto", "methodology": "case rate", "standard_charge_dollar": 22078.27, "additional_payer_notes": "170.00% of Medicare Rates" }, { "payer_name": "Coventry", "plan_name": "Coventry Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 22078.27, "additional_payer_notes": "170.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "case rate", "standard_charge_dollar": 16883.39, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Fairprice Healthcare Holdings", "plan_name": "Fairprice Healthcare Holdings", "methodology": "case rate", "standard_charge_dollar": 20779.55, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon Medicare", "methodology": "case rate", "standard_charge_dollar": 10735.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon NJ Health Medicaid", "methodology": "case rate", "standard_charge_dollar": 6581.53 }, { "payer_name": "Humana", "plan_name": "Humana Military Tricare", "methodology": "case rate", "standard_charge_dollar": 10389.78, "additional_payer_notes": "80.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 12987.22, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 11667.9 }, { "payer_name": "UBH", "plan_name": "UBH Medicare", "methodology": "case rate", "standard_charge_dollar": 10735.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC All Payer (02-01-2023 to 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 16672.27 }, { "payer_name": "UHC", "plan_name": "UHC Oxford (02-01-2023 to 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 14529.88 }, { "payer_name": "UHC - Adhoc", "plan_name": "UHC - Adhoc All Payer", "methodology": "case rate", "standard_charge_dollar": 17697.97 }, { "payer_name": "UHC - Adhoc", "plan_name": "UHC - Adhoc Oxford", "methodology": "case rate", "standard_charge_dollar": 14973.0 }, { "payer_name": "Wellcare", "plan_name": "Wellcare Insurance Exchange", "methodology": "case rate", "standard_charge_dollar": 17532.75, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "case rate", "standard_charge_dollar": 10735.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup Medicare", "methodology": "case rate", "standard_charge_dollar": 10735.1, "additional_payer_notes": "100.00% of Medicare Rates" } ] } ] }, { "description": "NEONATE BIRTHWT 1500-1999G W CONGENITALPERINATAL INFECTION - SOI : 3", "code_information": [ { "code": "6133", "type": "APR-DRG" } ], "standard_charges": [ { "setting": "inpatient", "minimum": 54559.47, "maximum": 60015.41, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Better Health - Medi Medi", "methodology": "case rate", "standard_charge_dollar": 60015.41, "additional_payer_notes": "110% of State Medicaid Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Better Health Medicaid", "methodology": "case rate", "standard_charge_dollar": 60015.41, "additional_payer_notes": "110% of State Medicaid Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "case rate", "standard_charge_dollar": 54559.47, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "UBH", "plan_name": "UBH Medicaid", "methodology": "case rate", "standard_charge_dollar": 54559.47, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicaid (02/01/2023 to 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 55650.66, "additional_payer_notes": "102% of State Medicaid Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicaid", "methodology": "case rate", "standard_charge_dollar": 54559.47, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup Medicaid", "methodology": "case rate", "standard_charge_dollar": 54559.47, "additional_payer_notes": "100% of State Medicaid Rates" } ] } ] }, { "description": "Hc Csf Fluid Scan Cisternography", "code_information": [ { "code": "78630", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 996.0, "discounted_cash": 641.0, "minimum": 190.1364, "maximum": 996.0, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 996.0, "additional_payer_notes": "212.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medical Rental Network", "methodology": "fee schedule", "standard_charge_dollar": 996.0, "additional_payer_notes": "212.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 641.9, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "ALLY-ALIGN (FKA SPARTAN PLAN NJ, INC.)", "plan_name": "ALLY-ALIGN (FKA SPARTAN PLAN NJ, INC.)", "methodology": "fee schedule", "standard_charge_dollar": 674.0, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Americhoice (UHC)", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 641.9, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Amerihealth", "plan_name": "Amerihealth Medicare", "methodology": "fee schedule", "standard_charge_dollar": 641.9, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 943.27, "additional_payer_notes": "146.95% of Medicare Rates" }, { "payer_name": "Clover Health", "plan_name": "Clover Medicare", "methodology": "fee schedule", "standard_charge_dollar": 641.9, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Coventry", "plan_name": "Coventry Auto", "methodology": "fee schedule", "standard_charge_dollar": 996.0, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Coventry", "plan_name": "Coventry Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 996.0, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "fee schedule", "standard_charge_dollar": 898.66, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Fairprice Healthcare Holdings", "plan_name": "Fairprice Healthcare Holdings", "methodology": "fee schedule", "standard_charge_dollar": 996.0, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ HMO POS", "methodology": "fee schedule", "standard_charge_dollar": 996.0, "additional_payer_notes": "177.30% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ Indemnity", "methodology": "fee schedule", "standard_charge_dollar": 996.0, "additional_payer_notes": "177.30% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ PPO", "methodology": "fee schedule", "standard_charge_dollar": 996.0, "additional_payer_notes": "177.30% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon Medicare", "methodology": "fee schedule", "standard_charge_dollar": 641.9, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Military Tricare", "methodology": "fee schedule", "standard_charge_dollar": 513.52, "additional_payer_notes": "80.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 641.9, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 641.9, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC All Payer (02-01-2023 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 734.1 }, { "payer_name": "UHC", "plan_name": "UHC Oxford (02-01-2023 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 734.1 }, { "payer_name": "UHC - Adhoc", "plan_name": "UHC - Adhoc All Payer", "methodology": "fee schedule", "standard_charge_dollar": 489.4 }, { "payer_name": "UHC - Adhoc", "plan_name": "UHC - Adhoc Oxford", "methodology": "fee schedule", "standard_charge_dollar": 489.4 }, { "payer_name": "Wellcare", "plan_name": "Wellcare Insurance Exchange", "methodology": "fee schedule", "standard_charge_dollar": 866.57, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 641.9, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup Medicare", "methodology": "fee schedule", "standard_charge_dollar": 641.9, "additional_payer_notes": "100.00% of Medicare Rates" } ] } ] }, { "description": "Hc Radiologic Exam Abdomen 3+ Views", "code_information": [ { "code": "74021", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 540.0, "discounted_cash": 123.0, "minimum": 59.64, "maximum": 459.0, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 262.01, "additional_payer_notes": "212.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medical Rental Network", "methodology": "fee schedule", "standard_charge_dollar": 262.01, "additional_payer_notes": "212.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 123.59, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "ALLY-ALIGN (FKA SPARTAN PLAN NJ, INC.)", "plan_name": "ALLY-ALIGN (FKA SPARTAN PLAN NJ, INC.)", "methodology": "fee schedule", "standard_charge_dollar": 129.77, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Americhoice (UHC)", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 123.59, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Amerihealth", "plan_name": "Amerihealth HMO", "methodology": "fee schedule", "standard_charge_dollar": 59.64 }, { "payer_name": "Amerihealth", "plan_name": "Amerihealth Medicare", "methodology": "fee schedule", "standard_charge_dollar": 123.59, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 181.62, "additional_payer_notes": "146.95% of Medicare Rates" }, { "payer_name": "Clover Health", "plan_name": "Clover Medicare", "methodology": "fee schedule", "standard_charge_dollar": 123.59, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Coventry", "plan_name": "Coventry Auto", "methodology": "fee schedule", "standard_charge_dollar": 247.18, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Coventry", "plan_name": "Coventry Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 247.18, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "fee schedule", "standard_charge_dollar": 173.03, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Fairprice Healthcare Holdings", "plan_name": "Fairprice Healthcare Holdings", "methodology": "fee schedule", "standard_charge_dollar": 197.74, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ HMO POS", "methodology": "fee schedule", "standard_charge_dollar": 219.13, "additional_payer_notes": "177.30% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ Indemnity", "methodology": "fee schedule", "standard_charge_dollar": 219.13, "additional_payer_notes": "177.30% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ PPO", "methodology": "fee schedule", "standard_charge_dollar": 219.13, "additional_payer_notes": "177.30% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon Medicare", "methodology": "fee schedule", "standard_charge_dollar": 123.59, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon NJ Health Medicaid", "methodology": "percent of total billed charges", "standard_charge_percentage": 19.58, "median_amount": 105.73, "10th_percentile": 105.73, "90th_percentile": 105.73, "count": "1 through 10" }, { "payer_name": "Humana", "plan_name": "Humana Military Tricare", "methodology": "fee schedule", "standard_charge_dollar": 98.87, "additional_payer_notes": "80.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 123.59, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 123.59, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC All Payer (02-01-2023 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 163.46 }, { "payer_name": "UHC", "plan_name": "UHC Medicaid (02/01/2023 to 12-31-2026)", "methodology": "percent of total billed charges", "standard_charge_percentage": 19.47, "median_amount": 102.72, "10th_percentile": 102.72, "90th_percentile": 102.72, "count": "1 through 10" }, { "payer_name": "UHC", "plan_name": "UHC Oxford (02-01-2023 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 163.46 }, { "payer_name": "UHC - Adhoc", "plan_name": "UHC - Adhoc All Payer", "methodology": "fee schedule", "standard_charge_dollar": 108.97 }, { "payer_name": "UHC - Adhoc", "plan_name": "UHC - Adhoc Oxford", "methodology": "fee schedule", "standard_charge_dollar": 108.97 }, { "payer_name": "Wellcare", "plan_name": "Wellcare Insurance Exchange", "methodology": "fee schedule", "standard_charge_dollar": 166.85, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 123.59, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup Medicare", "methodology": "fee schedule", "standard_charge_dollar": 123.59, "additional_payer_notes": "100.00% of Medicare Rates" } ] } ] }, { "description": "Hc Intra-Arterial Particulate Admin", "code_information": [ { "code": "79445", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 1154.45, "discounted_cash": 275.0, "minimum": 220.3845, "maximum": 981.2825, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 584.78, "additional_payer_notes": "212.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medical Rental Network", "methodology": "fee schedule", "standard_charge_dollar": 584.78, "additional_payer_notes": "212.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 275.84, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "ALLY-ALIGN (FKA SPARTAN PLAN NJ, INC.)", "plan_name": "ALLY-ALIGN (FKA SPARTAN PLAN NJ, INC.)", "methodology": "fee schedule", "standard_charge_dollar": 289.63, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Americhoice (UHC)", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 275.84, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Amerihealth", "plan_name": "Amerihealth HMO", "methodology": "fee schedule", "standard_charge_dollar": 354.64 }, { "payer_name": "Amerihealth", "plan_name": "Amerihealth Medicare", "methodology": "fee schedule", "standard_charge_dollar": 275.84, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 405.35, "additional_payer_notes": "146.95% of Medicare Rates" }, { "payer_name": "Clover Health", "plan_name": "Clover Medicare", "methodology": "fee schedule", "standard_charge_dollar": 275.84, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Coventry", "plan_name": "Coventry Auto", "methodology": "fee schedule", "standard_charge_dollar": 551.68, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Coventry", "plan_name": "Coventry Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 551.68, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "fee schedule", "standard_charge_dollar": 386.18, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Fairprice Healthcare Holdings", "plan_name": "Fairprice Healthcare Holdings", "methodology": "fee schedule", "standard_charge_dollar": 441.34, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ HMO POS", "methodology": "fee schedule", "standard_charge_dollar": 489.06, "additional_payer_notes": "177.30% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ Indemnity", "methodology": "fee schedule", "standard_charge_dollar": 489.06, "additional_payer_notes": "177.30% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ PPO", "methodology": "fee schedule", "standard_charge_dollar": 489.06, "additional_payer_notes": "177.30% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon Medicare", "methodology": "fee schedule", "standard_charge_dollar": 275.84, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Military Tricare", "methodology": "fee schedule", "standard_charge_dollar": 220.67, "additional_payer_notes": "80.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 275.84, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 275.84, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC All Payer (02-01-2023 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 374.43 }, { "payer_name": "UHC", "plan_name": "UHC Oxford (02-01-2023 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 374.43 }, { "payer_name": "UHC - Adhoc", "plan_name": "UHC - Adhoc All Payer", "methodology": "fee schedule", "standard_charge_dollar": 249.62 }, { "payer_name": "UHC - Adhoc", "plan_name": "UHC - Adhoc Oxford", "methodology": "fee schedule", "standard_charge_dollar": 249.62 }, { "payer_name": "Wellcare", "plan_name": "Wellcare Insurance Exchange", "methodology": "fee schedule", "standard_charge_dollar": 372.38, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 275.84, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup Medicare", "methodology": "fee schedule", "standard_charge_dollar": 275.84, "additional_payer_notes": "100.00% of Medicare Rates" } ] } ] }, { "description": "Hc Htlv-Ii Antibody", "code_information": [ { "code": "86688", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 50.0, "discounted_cash": 14.0, "minimum": 8.4, "maximum": 42.5, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 29.68, "additional_payer_notes": "212.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medical Rental Network", "methodology": "fee schedule", "standard_charge_dollar": 29.68, "additional_payer_notes": "212.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 14.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "ALLY-ALIGN (FKA SPARTAN PLAN NJ, INC.)", "plan_name": "ALLY-ALIGN (FKA SPARTAN PLAN NJ, INC.)", "methodology": "fee schedule", "standard_charge_dollar": 14.7, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Americhoice (UHC)", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 14.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Amerihealth", "plan_name": "Amerihealth Medicare", "methodology": "fee schedule", "standard_charge_dollar": 14.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 20.3, "additional_payer_notes": "Laboratory - 145.00% of Medicare Rates" }, { "payer_name": "Clover Health", "plan_name": "Clover Medicare", "methodology": "fee schedule", "standard_charge_dollar": 14.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Coventry", "plan_name": "Coventry Auto", "methodology": "fee schedule", "standard_charge_dollar": 28.0, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Coventry", "plan_name": "Coventry Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 28.0, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "fee schedule", "standard_charge_dollar": 19.6, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Fairprice Healthcare Holdings", "plan_name": "Fairprice Healthcare Holdings", "methodology": "fee schedule", "standard_charge_dollar": 16.8, "additional_payer_notes": "Laboratory - 120.00% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ HMO POS", "methodology": "fee schedule", "standard_charge_dollar": 35.3, "additional_payer_notes": "177.30% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ Indemnity", "methodology": "fee schedule", "standard_charge_dollar": 35.3, "additional_payer_notes": "177.30% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ PPO", "methodology": "fee schedule", "standard_charge_dollar": 35.3, "additional_payer_notes": "177.30% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon Medicare", "methodology": "fee schedule", "standard_charge_dollar": 14.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Military Tricare", "methodology": "fee schedule", "standard_charge_dollar": 11.2, "additional_payer_notes": "80.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 14.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 14.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC All Payer (02-01-2023 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 8.4 }, { "payer_name": "UHC", "plan_name": "UHC Medicaid (02/01/2023 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 11.2 }, { "payer_name": "UHC", "plan_name": "UHC Oxford (02-01-2023 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 8.4 }, { "payer_name": "UHC - Adhoc", "plan_name": "UHC - Adhoc All Payer", "methodology": "fee schedule", "standard_charge_dollar": 14.0 }, { "payer_name": "UHC - Adhoc", "plan_name": "UHC - Adhoc Oxford", "methodology": "fee schedule", "standard_charge_dollar": 14.0 }, { "payer_name": "Wellcare", "plan_name": "Wellcare Insurance Exchange", "methodology": "fee schedule", "standard_charge_dollar": 18.9, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 14.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup Medicare", "methodology": "fee schedule", "standard_charge_dollar": 14.0, "additional_payer_notes": "100.00% of Medicare Rates" } ] } ] }, { "description": "ISCHEMIC STROKE, PRECEREBRAL OCCLUSION OR TRANSIENT ISCHEMIA WITH THROMBOLYTIC AGENT WITHOUT CCMCC", "code_information": [ { "code": "063", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 17779.0, "minimum": 10165.78, "maximum": 32181.2389, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "case rate", "standard_charge_dollar": 32181.24, "additional_payer_notes": "181.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medical Rental Network", "methodology": "case rate", "standard_charge_dollar": 32181.24, "additional_payer_notes": "181.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "case rate", "standard_charge_dollar": 14583.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "ALLY-ALIGN (FKA SPARTAN PLAN NJ, INC.)", "plan_name": "ALLY-ALIGN (FKA SPARTAN PLAN NJ, INC.)", "methodology": "case rate", "standard_charge_dollar": 18668.67, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Americhoice (UHC)", "plan_name": "UHC Medicare", "methodology": "case rate", "standard_charge_dollar": 14583.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Amerihealth", "plan_name": "Amerihealth Medicare", "methodology": "case rate", "standard_charge_dollar": 14583.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Commercial", "methodology": "case rate", "standard_charge_dollar": 20537.59 }, { "payer_name": "Clover Health", "plan_name": "Clover Medicare", "methodology": "case rate", "standard_charge_dollar": 14583.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Coventry", "plan_name": "Coventry Auto", "methodology": "case rate", "standard_charge_dollar": 30225.47, "additional_payer_notes": "170.00% of Medicare Rates" }, { "payer_name": "Coventry", "plan_name": "Coventry Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 30225.47, "additional_payer_notes": "170.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "case rate", "standard_charge_dollar": 23113.6, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Fairprice Healthcare Holdings", "plan_name": "Fairprice Healthcare Holdings", "methodology": "case rate", "standard_charge_dollar": 28447.5, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon Medicare", "methodology": "case rate", "standard_charge_dollar": 14583.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon NJ Health Medicaid", "methodology": "case rate", "standard_charge_dollar": 10165.78 }, { "payer_name": "Humana", "plan_name": "Humana Military Tricare", "methodology": "case rate", "standard_charge_dollar": 14223.75, "additional_payer_notes": "80.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 17779.69, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 17829.6 }, { "payer_name": "UBH", "plan_name": "UBH Medicare", "methodology": "case rate", "standard_charge_dollar": 14583.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC All Payer (02-01-2023 to 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 23662.45 }, { "payer_name": "UHC", "plan_name": "UHC Oxford (02-01-2023 to 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 20621.82 }, { "payer_name": "UHC - Adhoc", "plan_name": "UHC - Adhoc All Payer", "methodology": "case rate", "standard_charge_dollar": 25118.19 }, { "payer_name": "UHC - Adhoc", "plan_name": "UHC - Adhoc Oxford", "methodology": "case rate", "standard_charge_dollar": 21250.72 }, { "payer_name": "Wellcare", "plan_name": "Wellcare Insurance Exchange", "methodology": "case rate", "standard_charge_dollar": 24002.58, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "case rate", "standard_charge_dollar": 14583.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup Medicare", "methodology": "case rate", "standard_charge_dollar": 14583.3, "additional_payer_notes": "100.00% of Medicare Rates" } ] } ] }, { "description": "Hc Detect Agent,Immun,Dir Obs,Influenza", "code_information": [ { "code": "87804", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 177.0, "discounted_cash": 16.0, "minimum": 9.93, "maximum": 150.45, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 35.09, "additional_payer_notes": "212.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medical Rental Network", "methodology": "fee schedule", "standard_charge_dollar": 35.09, "additional_payer_notes": "212.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 16.55, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "ALLY-ALIGN (FKA SPARTAN PLAN NJ, INC.)", "plan_name": "ALLY-ALIGN (FKA SPARTAN PLAN NJ, INC.)", "methodology": "fee schedule", "standard_charge_dollar": 17.38, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Americhoice (UHC)", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 16.55, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Amerihealth", "plan_name": "Amerihealth Medicare", "methodology": "fee schedule", "standard_charge_dollar": 16.55, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 24.0, "additional_payer_notes": "Laboratory - 145.00% of Medicare Rates" }, { "payer_name": "Clover Health", "plan_name": "Clover Medicare", "methodology": "fee schedule", "standard_charge_dollar": 16.55, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Coventry", "plan_name": "Coventry Auto", "methodology": "fee schedule", "standard_charge_dollar": 33.1, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Coventry", "plan_name": "Coventry Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 33.1, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "fee schedule", "standard_charge_dollar": 23.17, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Fairprice Healthcare Holdings", "plan_name": "Fairprice Healthcare Holdings", "methodology": "fee schedule", "standard_charge_dollar": 19.86, "additional_payer_notes": "Laboratory - 120.00% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ HMO POS", "methodology": "fee schedule", "standard_charge_dollar": 124.96, "additional_payer_notes": "177.30% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ Indemnity", "methodology": "fee schedule", "standard_charge_dollar": 124.96, "additional_payer_notes": "177.30% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ PPO", "methodology": "fee schedule", "standard_charge_dollar": 124.96, "additional_payer_notes": "177.30% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon Medicare", "methodology": "fee schedule", "standard_charge_dollar": 16.55, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Military Tricare", "methodology": "fee schedule", "standard_charge_dollar": 13.24, "additional_payer_notes": "80.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 16.55, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 16.55, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC All Payer (02-01-2023 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 9.93 }, { "payer_name": "UHC", "plan_name": "UHC Medicaid (02/01/2023 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 13.24 }, { "payer_name": "UHC", "plan_name": "UHC Oxford (02-01-2023 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 9.93 }, { "payer_name": "UHC - Adhoc", "plan_name": "UHC - Adhoc All Payer", "methodology": "fee schedule", "standard_charge_dollar": 16.55 }, { "payer_name": "UHC - Adhoc", "plan_name": "UHC - Adhoc Oxford", "methodology": "fee schedule", "standard_charge_dollar": 16.55 }, { "payer_name": "Wellcare", "plan_name": "Wellcare Insurance Exchange", "methodology": "fee schedule", "standard_charge_dollar": 22.34, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 16.55, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup Medicaid", "methodology": "percent of total billed charges", "standard_charge_percentage": 19.09, "median_amount": 33.01, "10th_percentile": 33.01, "90th_percentile": 33.01, "count": "183" }, { "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup Medicare", "methodology": "fee schedule", "standard_charge_dollar": 16.55, "additional_payer_notes": "100.00% of Medicare Rates" } ] } ] }, { "description": "Repair Elbow Deb/Attch Open", "code_information": [ { "code": "24359", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 29119.0, "discounted_cash": 3868.0, "minimum": 1715.0, "maximum": 23295.2, "payers_information": [ { "payer_name": "Horizon", "plan_name": "Horizon NJ Health Medicaid", "methodology": "percent of total billed charges", "standard_charge_percentage": 19.58, "median_amount": 1004.45, "10th_percentile": 1004.45, "90th_percentile": 1004.45, "count": "1 through 10" }, { "payer_name": "Humana", "plan_name": "Humana Military Tricare", "methodology": "fee schedule", "standard_charge_dollar": 3094.54, "additional_payer_notes": "80.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3868.17, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 3868.17, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC All Payer (02-01-2023 to 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 5378.0 }, { "payer_name": "UHC", "plan_name": "UHC Oxford (02-01-2023 to 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 5169.0 }, { "payer_name": "UHC - Adhoc", "plan_name": "UHC - Adhoc All Payer", "methodology": "case rate", "standard_charge_dollar": 5709.0 }, { "payer_name": "UHC - Adhoc", "plan_name": "UHC - Adhoc Oxford", "methodology": "case rate", "standard_charge_dollar": 5327.0 }, { "payer_name": "Wellcare", "plan_name": "Wellcare Insurance Exchange", "methodology": "fee schedule", "standard_charge_dollar": 5222.03, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3868.17, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellchoice", "plan_name": "WELLCHOICE HMO of NJ (Empire) Commercial (HMO / HMO POS, PPO)", "methodology": "case rate", "standard_charge_dollar": 1715.0 }, { "payer_name": "Wellchoice", "plan_name": "WELLCHOICE HMO of NJ (Empire) Commercial (Indemnity)", "methodology": "case rate", "standard_charge_dollar": 1978.0 }, { "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3868.17, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 8200.52, "additional_payer_notes": "212.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medical Rental Network", "methodology": "fee schedule", "standard_charge_dollar": 8200.52, "additional_payer_notes": "212.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3868.17, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "ALLY-ALIGN (FKA SPARTAN PLAN NJ, INC.)", "plan_name": "ALLY-ALIGN (FKA SPARTAN PLAN NJ, INC.)", "methodology": "fee schedule", "standard_charge_dollar": 4061.58, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Americhoice (UHC)", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3868.17, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Amerihealth", "plan_name": "Amerihealth Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3868.17, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 5684.28, "additional_payer_notes": "146.95% of Medicare Rates" }, { "payer_name": "Clover Health", "plan_name": "Clover Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3868.17, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Coventry", "plan_name": "Coventry Auto", "methodology": "fee schedule", "standard_charge_dollar": 7736.34, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Coventry", "plan_name": "Coventry Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 7736.34, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "fee schedule", "standard_charge_dollar": 5415.44, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Fairprice Healthcare Holdings", "plan_name": "Fairprice Healthcare Holdings", "methodology": "fee schedule", "standard_charge_dollar": 6189.07, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ HMO POS", "methodology": "fee schedule", "standard_charge_dollar": 6858.27, "additional_payer_notes": "177.30% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ Indemnity", "methodology": "fee schedule", "standard_charge_dollar": 6858.27, "additional_payer_notes": "177.30% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ PPO", "methodology": "fee schedule", "standard_charge_dollar": 6858.27, "additional_payer_notes": "177.30% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3868.17, "additional_payer_notes": "100.00% of Medicare Rates" } ] } ] }, { "description": "Hc Clsd Treat Mc-P Disloc W Manip Wo Anes", "code_information": [ { "code": "26700", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 968.12, "discounted_cash": 291.0, "minimum": 184.8141, "maximum": 968.12, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 618.19, "additional_payer_notes": "212.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medical Rental Network", "methodology": "fee schedule", "standard_charge_dollar": 618.19, "additional_payer_notes": "212.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 291.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "ALLY-ALIGN (FKA SPARTAN PLAN NJ, INC.)", "plan_name": "ALLY-ALIGN (FKA SPARTAN PLAN NJ, INC.)", "methodology": "fee schedule", "standard_charge_dollar": 306.18, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Americhoice (UHC)", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 291.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Amerihealth", "plan_name": "Amerihealth Medicare", "methodology": "fee schedule", "standard_charge_dollar": 291.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 428.51, "additional_payer_notes": "146.95% of Medicare Rates" }, { "payer_name": "Clover Health", "plan_name": "Clover Medicare", "methodology": "fee schedule", "standard_charge_dollar": 291.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Coventry", "plan_name": "Coventry Auto", "methodology": "fee schedule", "standard_charge_dollar": 583.2, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Coventry", "plan_name": "Coventry Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 583.2, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "fee schedule", "standard_charge_dollar": 408.24, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Fairprice Healthcare Holdings", "plan_name": "Fairprice Healthcare Holdings", "methodology": "fee schedule", "standard_charge_dollar": 466.56, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ HMO POS", "methodology": "fee schedule", "standard_charge_dollar": 517.01, "additional_payer_notes": "177.30% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ Indemnity", "methodology": "fee schedule", "standard_charge_dollar": 517.01, "additional_payer_notes": "177.30% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ PPO", "methodology": "fee schedule", "standard_charge_dollar": 517.01, "additional_payer_notes": "177.30% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon Medicare", "methodology": "fee schedule", "standard_charge_dollar": 291.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Military Tricare", "methodology": "fee schedule", "standard_charge_dollar": 233.28, "additional_payer_notes": "80.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 291.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 291.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC All Payer (02-01-2023 to 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 968.12 }, { "payer_name": "UHC", "plan_name": "UHC Oxford (02-01-2023 to 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 968.12 }, { "payer_name": "UHC - Adhoc", "plan_name": "UHC - Adhoc All Payer", "methodology": "case rate", "standard_charge_dollar": 968.12 }, { "payer_name": "UHC - Adhoc", "plan_name": "UHC - Adhoc Oxford", "methodology": "case rate", "standard_charge_dollar": 968.12 }, { "payer_name": "Wellcare", "plan_name": "Wellcare Insurance Exchange", "methodology": "fee schedule", "standard_charge_dollar": 393.66, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 291.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup Medicare", "methodology": "fee schedule", "standard_charge_dollar": 291.6, "additional_payer_notes": "100.00% of Medicare Rates" } ] } ] }, { "description": "Hc App Skn Sub Trnk/Arm/Leg >=100Sqcm 1St 100Sqcm", "code_information": [ { "code": "15273", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 10687.5, "discounted_cash": 2439.0, "minimum": 1715.0, "maximum": 8550.0, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 5171.15, "additional_payer_notes": "212.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medical Rental Network", "methodology": "fee schedule", "standard_charge_dollar": 5171.15, "additional_payer_notes": "212.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2439.22, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "ALLY-ALIGN (FKA SPARTAN PLAN NJ, INC.)", "plan_name": "ALLY-ALIGN (FKA SPARTAN PLAN NJ, INC.)", "methodology": "fee schedule", "standard_charge_dollar": 2561.18, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Americhoice (UHC)", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2439.22, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Amerihealth", "plan_name": "Amerihealth Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2439.22, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 3584.43, "additional_payer_notes": "146.95% of Medicare Rates" }, { "payer_name": "Clover Health", "plan_name": "Clover Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2439.22, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Coventry", "plan_name": "Coventry Auto", "methodology": "fee schedule", "standard_charge_dollar": 4878.44, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Coventry", "plan_name": "Coventry Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 4878.44, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "fee schedule", "standard_charge_dollar": 3414.91, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Fairprice Healthcare Holdings", "plan_name": "Fairprice Healthcare Holdings", "methodology": "fee schedule", "standard_charge_dollar": 3902.75, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ HMO POS", "methodology": "fee schedule", "standard_charge_dollar": 4324.74, "additional_payer_notes": "177.30% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ Indemnity", "methodology": "fee schedule", "standard_charge_dollar": 4324.74, "additional_payer_notes": "177.30% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ PPO", "methodology": "fee schedule", "standard_charge_dollar": 4324.74, "additional_payer_notes": "177.30% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2439.22, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Military Tricare", "methodology": "fee schedule", "standard_charge_dollar": 1951.38, "additional_payer_notes": "80.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2439.22, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 2439.22, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC All Payer (02-01-2023 to 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 5378.0 }, { "payer_name": "UHC", "plan_name": "UHC Oxford (02-01-2023 to 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 5169.0 }, { "payer_name": "UHC - Adhoc", "plan_name": "UHC - Adhoc All Payer", "methodology": "case rate", "standard_charge_dollar": 5709.0 }, { "payer_name": "UHC - Adhoc", "plan_name": "UHC - Adhoc Oxford", "methodology": "case rate", "standard_charge_dollar": 5327.0 }, { "payer_name": "Wellcare", "plan_name": "Wellcare Insurance Exchange", "methodology": "fee schedule", "standard_charge_dollar": 3292.95, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2439.22, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellchoice", "plan_name": "WELLCHOICE HMO of NJ (Empire) Commercial (HMO / HMO POS, PPO)", "methodology": "case rate", "standard_charge_dollar": 1715.0 }, { "payer_name": "Wellchoice", "plan_name": "WELLCHOICE HMO of NJ (Empire) Commercial (Indemnity)", "methodology": "case rate", "standard_charge_dollar": 1978.0 }, { "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2439.22, "additional_payer_notes": "100.00% of Medicare Rates" } ] } ] }, { "description": "Hc Assay Of Carnitine", "code_information": [ { "code": "82379", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 59.0, "discounted_cash": 16.0, "minimum": 10.12, "maximum": 50.15, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 35.76, "additional_payer_notes": "212.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medical Rental Network", "methodology": "fee schedule", "standard_charge_dollar": 35.76, "additional_payer_notes": "212.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 16.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "ALLY-ALIGN (FKA SPARTAN PLAN NJ, INC.)", "plan_name": "ALLY-ALIGN (FKA SPARTAN PLAN NJ, INC.)", "methodology": "fee schedule", "standard_charge_dollar": 17.71, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Americhoice (UHC)", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 16.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Amerihealth", "plan_name": "Amerihealth Medicare", "methodology": "fee schedule", "standard_charge_dollar": 16.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 24.46, "additional_payer_notes": "Laboratory - 145.00% of Medicare Rates" }, { "payer_name": "Clover Health", "plan_name": "Clover Medicare", "methodology": "fee schedule", "standard_charge_dollar": 16.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Coventry", "plan_name": "Coventry Auto", "methodology": "fee schedule", "standard_charge_dollar": 33.74, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Coventry", "plan_name": "Coventry Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 33.74, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "fee schedule", "standard_charge_dollar": 23.62, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Fairprice Healthcare Holdings", "plan_name": "Fairprice Healthcare Holdings", "methodology": "fee schedule", "standard_charge_dollar": 20.24, "additional_payer_notes": "Laboratory - 120.00% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ HMO POS", "methodology": "fee schedule", "standard_charge_dollar": 41.65, "additional_payer_notes": "177.30% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ Indemnity", "methodology": "fee schedule", "standard_charge_dollar": 41.65, "additional_payer_notes": "177.30% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ PPO", "methodology": "fee schedule", "standard_charge_dollar": 41.65, "additional_payer_notes": "177.30% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon Medicare", "methodology": "fee schedule", "standard_charge_dollar": 16.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Military Tricare", "methodology": "fee schedule", "standard_charge_dollar": 13.5, "additional_payer_notes": "80.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 16.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 16.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC All Payer (02-01-2023 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 10.12 }, { "payer_name": "UHC", "plan_name": "UHC Medicaid (02/01/2023 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 13.5 }, { "payer_name": "UHC", "plan_name": "UHC Oxford (02-01-2023 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 10.12 }, { "payer_name": "UHC - Adhoc", "plan_name": "UHC - Adhoc All Payer", "methodology": "fee schedule", "standard_charge_dollar": 16.87 }, { "payer_name": "UHC - Adhoc", "plan_name": "UHC - Adhoc Oxford", "methodology": "fee schedule", "standard_charge_dollar": 16.87 }, { "payer_name": "Wellcare", "plan_name": "Wellcare Insurance Exchange", "methodology": "fee schedule", "standard_charge_dollar": 22.77, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 16.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup Medicare", "methodology": "fee schedule", "standard_charge_dollar": 16.87, "additional_payer_notes": "100.00% of Medicare Rates" } ] } ] }, { "description": "Hc Psychotherapy Patient &/ Family 45 Minutes", "code_information": [ { "code": "90834", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 654.51, "discounted_cash": 209.0, "minimum": 79.31, "maximum": 556.3335, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 444.84, "additional_payer_notes": "212.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medical Rental Network", "methodology": "fee schedule", "standard_charge_dollar": 444.84, "additional_payer_notes": "212.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 209.83, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "ALLY-ALIGN (FKA SPARTAN PLAN NJ, INC.)", "plan_name": "ALLY-ALIGN (FKA SPARTAN PLAN NJ, INC.)", "methodology": "fee schedule", "standard_charge_dollar": 220.32, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Americhoice (UHC)", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 209.83, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Amerihealth", "plan_name": "Amerihealth HMO", "methodology": "fee schedule", "standard_charge_dollar": 97.62 }, { "payer_name": "Amerihealth", "plan_name": "Amerihealth Medicare", "methodology": "fee schedule", "standard_charge_dollar": 97.62, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 308.35, "additional_payer_notes": "146.95% of Medicare Rates" }, { "payer_name": "Clover Health", "plan_name": "Clover Medicare", "methodology": "fee schedule", "standard_charge_dollar": 209.83, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Coventry", "plan_name": "Coventry Auto", "methodology": "fee schedule", "standard_charge_dollar": 419.66, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Coventry", "plan_name": "Coventry Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 419.66, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "fee schedule", "standard_charge_dollar": 293.76, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Fairprice Healthcare Holdings", "plan_name": "Fairprice Healthcare Holdings", "methodology": "fee schedule", "standard_charge_dollar": 335.73, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ HMO POS", "methodology": "fee schedule", "standard_charge_dollar": 372.03, "additional_payer_notes": "177.30% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ Indemnity", "methodology": "fee schedule", "standard_charge_dollar": 372.03, "additional_payer_notes": "177.30% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ PPO", "methodology": "fee schedule", "standard_charge_dollar": 372.03, "additional_payer_notes": "177.30% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon Medicare", "methodology": "fee schedule", "standard_charge_dollar": 209.83, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon NJ Health Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 79.31 }, { "payer_name": "Humana", "plan_name": "Humana Military Tricare", "methodology": "fee schedule", "standard_charge_dollar": 167.86, "additional_payer_notes": "80.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 209.83, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 209.83, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UBH", "plan_name": "UBH Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 79.31 }, { "payer_name": "UHC", "plan_name": "UHC Medicaid (02/01/2023 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 79.31 }, { "payer_name": "Wellcare", "plan_name": "Wellcare Insurance Exchange", "methodology": "fee schedule", "standard_charge_dollar": 283.27, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 209.83, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup Medicare", "methodology": "fee schedule", "standard_charge_dollar": 209.83, "additional_payer_notes": "100.00% of Medicare Rates" } ] } ] }, { "description": "Hc Hep A Ab Test, Igm", "code_information": [ { "code": "86709", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 41.0, "discounted_cash": 11.0, "minimum": 6.76, "maximum": 34.85, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 23.87, "additional_payer_notes": "212.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medical Rental Network", "methodology": "fee schedule", "standard_charge_dollar": 23.87, "additional_payer_notes": "212.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 11.26, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "ALLY-ALIGN (FKA SPARTAN PLAN NJ, INC.)", "plan_name": "ALLY-ALIGN (FKA SPARTAN PLAN NJ, INC.)", "methodology": "fee schedule", "standard_charge_dollar": 11.82, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Americhoice (UHC)", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 11.26, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Amerihealth", "plan_name": "Amerihealth Medicare", "methodology": "fee schedule", "standard_charge_dollar": 11.26, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 16.33, "additional_payer_notes": "Laboratory - 145.00% of Medicare Rates" }, { "payer_name": "Clover Health", "plan_name": "Clover Medicare", "methodology": "fee schedule", "standard_charge_dollar": 11.26, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Coventry", "plan_name": "Coventry Auto", "methodology": "fee schedule", "standard_charge_dollar": 22.52, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Coventry", "plan_name": "Coventry Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 22.52, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "fee schedule", "standard_charge_dollar": 15.76, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Fairprice Healthcare Holdings", "plan_name": "Fairprice Healthcare Holdings", "methodology": "fee schedule", "standard_charge_dollar": 13.51, "additional_payer_notes": "Laboratory - 120.00% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ HMO POS", "methodology": "fee schedule", "standard_charge_dollar": 28.95, "additional_payer_notes": "177.30% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ Indemnity", "methodology": "fee schedule", "standard_charge_dollar": 28.95, "additional_payer_notes": "177.30% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ PPO", "methodology": "fee schedule", "standard_charge_dollar": 28.95, "additional_payer_notes": "177.30% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon Medicare", "methodology": "fee schedule", "standard_charge_dollar": 11.26, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Military Tricare", "methodology": "fee schedule", "standard_charge_dollar": 9.01, "additional_payer_notes": "80.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 11.26, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 11.26, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC All Payer (02-01-2023 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 6.76 }, { "payer_name": "UHC", "plan_name": "UHC Medicaid (02/01/2023 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 9.01 }, { "payer_name": "UHC", "plan_name": "UHC Oxford (02-01-2023 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 6.76 }, { "payer_name": "UHC - Adhoc", "plan_name": "UHC - Adhoc All Payer", "methodology": "fee schedule", "standard_charge_dollar": 11.26 }, { "payer_name": "UHC - Adhoc", "plan_name": "UHC - Adhoc Oxford", "methodology": "fee schedule", "standard_charge_dollar": 11.26 }, { "payer_name": "Wellcare", "plan_name": "Wellcare Insurance Exchange", "methodology": "fee schedule", "standard_charge_dollar": 15.2, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 11.26, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup Medicare", "methodology": "fee schedule", "standard_charge_dollar": 11.26, "additional_payer_notes": "100.00% of Medicare Rates" } ] } ] }, { "description": "Hc Assay Of Pyruvate Kinase", "code_information": [ { "code": "84220", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 89.0, "discounted_cash": 9.0, "minimum": 5.66, "maximum": 75.65, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 20.01, "additional_payer_notes": "212.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medical Rental Network", "methodology": "fee schedule", "standard_charge_dollar": 20.01, "additional_payer_notes": "212.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 9.44, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "ALLY-ALIGN (FKA SPARTAN PLAN NJ, INC.)", "plan_name": "ALLY-ALIGN (FKA SPARTAN PLAN NJ, INC.)", "methodology": "fee schedule", "standard_charge_dollar": 9.91, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Americhoice (UHC)", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 9.44, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Amerihealth", "plan_name": "Amerihealth Medicare", "methodology": "fee schedule", "standard_charge_dollar": 9.44, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 13.69, "additional_payer_notes": "Laboratory - 145.00% of Medicare Rates" }, { "payer_name": "Clover Health", "plan_name": "Clover Medicare", "methodology": "fee schedule", "standard_charge_dollar": 9.44, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Coventry", "plan_name": "Coventry Auto", "methodology": "fee schedule", "standard_charge_dollar": 18.88, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Coventry", "plan_name": "Coventry Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 18.88, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "fee schedule", "standard_charge_dollar": 13.22, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Fairprice Healthcare Holdings", "plan_name": "Fairprice Healthcare Holdings", "methodology": "fee schedule", "standard_charge_dollar": 11.33, "additional_payer_notes": "Laboratory - 120.00% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ HMO POS", "methodology": "fee schedule", "standard_charge_dollar": 62.83, "additional_payer_notes": "177.30% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ Indemnity", "methodology": "fee schedule", "standard_charge_dollar": 62.83, "additional_payer_notes": "177.30% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ PPO", "methodology": "fee schedule", "standard_charge_dollar": 62.83, "additional_payer_notes": "177.30% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon Medicare", "methodology": "fee schedule", "standard_charge_dollar": 9.44, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Military Tricare", "methodology": "fee schedule", "standard_charge_dollar": 7.55, "additional_payer_notes": "80.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 9.44, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 9.44, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC All Payer (02-01-2023 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 5.66 }, { "payer_name": "UHC", "plan_name": "UHC Medicaid (02/01/2023 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 7.55 }, { "payer_name": "UHC", "plan_name": "UHC Oxford (02-01-2023 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 5.66 }, { "payer_name": "UHC - Adhoc", "plan_name": "UHC - Adhoc All Payer", "methodology": "fee schedule", "standard_charge_dollar": 9.44 }, { "payer_name": "UHC - Adhoc", "plan_name": "UHC - Adhoc Oxford", "methodology": "fee schedule", "standard_charge_dollar": 9.44 }, { "payer_name": "Wellcare", "plan_name": "Wellcare Insurance Exchange", "methodology": "fee schedule", "standard_charge_dollar": 12.74, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 9.44, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup Medicare", "methodology": "fee schedule", "standard_charge_dollar": 9.44, "additional_payer_notes": "100.00% of Medicare Rates" } ] } ] }, { "description": "CHOLECYSTECTOMY EXCEPT BY LAPAROSCOPE WITHOUT C.D.E. WITH MCC", "code_information": [ { "code": "414", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 42727.0, "minimum": 22337.23, "maximum": 77337.318, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "case rate", "standard_charge_dollar": 77337.32, "additional_payer_notes": "181.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medical Rental Network", "methodology": "case rate", "standard_charge_dollar": 77337.32, "additional_payer_notes": "181.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "case rate", "standard_charge_dollar": 34616.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "ALLY-ALIGN (FKA SPARTAN PLAN NJ, INC.)", "plan_name": "ALLY-ALIGN (FKA SPARTAN PLAN NJ, INC.)", "methodology": "case rate", "standard_charge_dollar": 44864.19, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Americhoice (UHC)", "plan_name": "UHC Medicare", "methodology": "case rate", "standard_charge_dollar": 34616.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Amerihealth", "plan_name": "Amerihealth Medicare", "methodology": "case rate", "standard_charge_dollar": 34616.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Commercial", "methodology": "case rate", "standard_charge_dollar": 52120.84 }, { "payer_name": "Clover Health", "plan_name": "Clover Medicare", "methodology": "case rate", "standard_charge_dollar": 34616.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Coventry", "plan_name": "Coventry Auto", "methodology": "case rate", "standard_charge_dollar": 72637.26, "additional_payer_notes": "170.00% of Medicare Rates" }, { "payer_name": "Coventry", "plan_name": "Coventry Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 72637.26, "additional_payer_notes": "170.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "case rate", "standard_charge_dollar": 55546.14, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Fairprice Healthcare Holdings", "plan_name": "Fairprice Healthcare Holdings", "methodology": "case rate", "standard_charge_dollar": 68364.48, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon Medicare", "methodology": "case rate", "standard_charge_dollar": 34616.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon NJ Health Medicaid", "methodology": "case rate", "standard_charge_dollar": 22337.23 }, { "payer_name": "Humana", "plan_name": "Humana Military Tricare", "methodology": "case rate", "standard_charge_dollar": 34182.24, "additional_payer_notes": "80.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 42727.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 50976.2 }, { "payer_name": "UBH", "plan_name": "UBH Medicare", "methodology": "case rate", "standard_charge_dollar": 34616.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC All Payer (02-01-2023 to 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 60051.19 }, { "payer_name": "UHC", "plan_name": "UHC Oxford (02-01-2023 to 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 52334.59 }, { "payer_name": "UHC - Adhoc", "plan_name": "UHC - Adhoc All Payer", "methodology": "case rate", "standard_charge_dollar": 63745.6 }, { "payer_name": "UHC - Adhoc", "plan_name": "UHC - Adhoc Oxford", "methodology": "case rate", "standard_charge_dollar": 53930.64 }, { "payer_name": "Wellcare", "plan_name": "Wellcare Insurance Exchange", "methodology": "case rate", "standard_charge_dollar": 57682.53, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "case rate", "standard_charge_dollar": 34616.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup Medicare", "methodology": "case rate", "standard_charge_dollar": 34616.0, "additional_payer_notes": "100.00% of Medicare Rates" } ] } ] }, { "description": "Removal of ankle implant", "code_information": [ { "code": "27704", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 26780.0, "discounted_cash": 3868.0, "minimum": 1715.0, "maximum": 21424.0, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 8200.52, "additional_payer_notes": "212.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medical Rental Network", "methodology": "fee schedule", "standard_charge_dollar": 8200.52, "additional_payer_notes": "212.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3868.17, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "ALLY-ALIGN (FKA SPARTAN PLAN NJ, INC.)", "plan_name": "ALLY-ALIGN (FKA SPARTAN PLAN NJ, INC.)", "methodology": "fee schedule", "standard_charge_dollar": 4061.58, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Americhoice (UHC)", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3868.17, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Amerihealth", "plan_name": "Amerihealth Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3868.17, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 5684.28, "additional_payer_notes": "146.95% of Medicare Rates" }, { "payer_name": "Clover Health", "plan_name": "Clover Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3868.17, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Coventry", "plan_name": "Coventry Auto", "methodology": "fee schedule", "standard_charge_dollar": 7736.34, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Coventry", "plan_name": "Coventry Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 7736.34, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "fee schedule", "standard_charge_dollar": 5415.44, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Fairprice Healthcare Holdings", "plan_name": "Fairprice Healthcare Holdings", "methodology": "fee schedule", "standard_charge_dollar": 6189.07, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ HMO POS", "methodology": "fee schedule", "standard_charge_dollar": 6858.27, "additional_payer_notes": "177.30% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ Indemnity", "methodology": "fee schedule", "standard_charge_dollar": 6858.27, "additional_payer_notes": "177.30% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ PPO", "methodology": "fee schedule", "standard_charge_dollar": 6858.27, "additional_payer_notes": "177.30% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3868.17, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Military Tricare", "methodology": "fee schedule", "standard_charge_dollar": 3094.54, "additional_payer_notes": "80.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3868.17, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 3868.17, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC All Payer (02-01-2023 to 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 5378.0 }, { "payer_name": "UHC", "plan_name": "UHC Oxford (02-01-2023 to 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 5169.0 }, { "payer_name": "UHC - Adhoc", "plan_name": "UHC - Adhoc All Payer", "methodology": "case rate", "standard_charge_dollar": 5709.0 }, { "payer_name": "UHC - Adhoc", "plan_name": "UHC - Adhoc Oxford", "methodology": "case rate", "standard_charge_dollar": 5327.0 }, { "payer_name": "Wellcare", "plan_name": "Wellcare Insurance Exchange", "methodology": "fee schedule", "standard_charge_dollar": 5222.03, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3868.17, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellchoice", "plan_name": "WELLCHOICE HMO of NJ (Empire) Commercial (HMO / HMO POS, PPO)", "methodology": "case rate", "standard_charge_dollar": 1715.0 }, { "payer_name": "Wellchoice", "plan_name": "WELLCHOICE HMO of NJ (Empire) Commercial (Indemnity)", "methodology": "case rate", "standard_charge_dollar": 1978.0 }, { "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3868.17, "additional_payer_notes": "100.00% of Medicare Rates" } ] } ] }, { "description": "HEART FAILURE - SOI : 2", "code_information": [ { "code": "1942", "type": "APR-DRG" } ], "standard_charges": [ { "setting": "inpatient", "minimum": 8417.38, "maximum": 9259.12, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Better Health - Medi Medi", "methodology": "case rate", "standard_charge_dollar": 9259.12, "additional_payer_notes": "110% of State Medicaid Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Better Health Medicaid", "methodology": "case rate", "standard_charge_dollar": 9259.12, "additional_payer_notes": "110% of State Medicaid Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "case rate", "standard_charge_dollar": 8417.38, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "UBH", "plan_name": "UBH Medicaid", "methodology": "case rate", "standard_charge_dollar": 8417.38, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicaid (02/01/2023 to 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 8585.73, "additional_payer_notes": "102% of State Medicaid Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicaid", "methodology": "case rate", "standard_charge_dollar": 8417.38, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup Medicaid", "methodology": "case rate", "standard_charge_dollar": 8417.38, "additional_payer_notes": "100% of State Medicaid Rates" } ] } ] }, { "description": "Hc Bronchoscopy Diag W Bronch Bx", "code_information": [ { "code": "31625", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 400.0, "discounted_cash": 2104.0, "minimum": 76.36, "maximum": 400.0, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 400.0, "additional_payer_notes": "212.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medical Rental Network", "methodology": "fee schedule", "standard_charge_dollar": 400.0, "additional_payer_notes": "212.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 400.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "ALLY-ALIGN (FKA SPARTAN PLAN NJ, INC.)", "plan_name": "ALLY-ALIGN (FKA SPARTAN PLAN NJ, INC.)", "methodology": "fee schedule", "standard_charge_dollar": 400.0, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Americhoice (UHC)", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 400.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Amerihealth", "plan_name": "Amerihealth Medicare", "methodology": "fee schedule", "standard_charge_dollar": 400.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 400.0, "additional_payer_notes": "146.95% of Medicare Rates" }, { "payer_name": "Clover Health", "plan_name": "Clover Medicare", "methodology": "fee schedule", "standard_charge_dollar": 400.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Coventry", "plan_name": "Coventry Auto", "methodology": "fee schedule", "standard_charge_dollar": 400.0, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Coventry", "plan_name": "Coventry Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 400.0, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "fee schedule", "standard_charge_dollar": 400.0, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Fairprice Healthcare Holdings", "plan_name": "Fairprice Healthcare Holdings", "methodology": "fee schedule", "standard_charge_dollar": 400.0, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ HMO POS", "methodology": "fee schedule", "standard_charge_dollar": 400.0, "additional_payer_notes": "177.30% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ Indemnity", "methodology": "fee schedule", "standard_charge_dollar": 400.0, "additional_payer_notes": "177.30% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ PPO", "methodology": "fee schedule", "standard_charge_dollar": 400.0, "additional_payer_notes": "177.30% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon Medicare", "methodology": "fee schedule", "standard_charge_dollar": 400.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Military Tricare", "methodology": "fee schedule", "standard_charge_dollar": 400.0, "additional_payer_notes": "80.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 400.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 400.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC All Payer (02-01-2023 to 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 400.0 }, { "payer_name": "UHC", "plan_name": "UHC Oxford (02-01-2023 to 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 400.0 }, { "payer_name": "UHC - Adhoc", "plan_name": "UHC - Adhoc All Payer", "methodology": "case rate", "standard_charge_dollar": 400.0 }, { "payer_name": "UHC - Adhoc", "plan_name": "UHC - Adhoc Oxford", "methodology": "case rate", "standard_charge_dollar": 400.0 }, { "payer_name": "Wellcare", "plan_name": "Wellcare Insurance Exchange", "methodology": "fee schedule", "standard_charge_dollar": 400.0, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 400.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellchoice", "plan_name": "WELLCHOICE HMO of NJ (Empire) Commercial (HMO / HMO POS, PPO)", "methodology": "case rate", "standard_charge_dollar": 400.0 }, { "payer_name": "Wellchoice", "plan_name": "WELLCHOICE HMO of NJ (Empire) Commercial (Indemnity)", "methodology": "case rate", "standard_charge_dollar": 400.0 }, { "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup Medicare", "methodology": "fee schedule", "standard_charge_dollar": 400.0, "additional_payer_notes": "100.00% of Medicare Rates" } ] } ] }, { "description": "NEO BWT<500G OR 500-999G & GA<24WKS OR 500-749G W MAJ ANOM OR WOUT LIFE SUSTAINING INTERVENTION- SOI : 3", "code_information": [ { "code": "5893", "type": "APR-DRG" } ], "standard_charges": [ { "setting": "inpatient", "minimum": 48564.2, "maximum": 53420.61, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Better Health - Medi Medi", "methodology": "case rate", "standard_charge_dollar": 53420.61, "additional_payer_notes": "110% of State Medicaid Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Better Health Medicaid", "methodology": "case rate", "standard_charge_dollar": 53420.61, "additional_payer_notes": "110% of State Medicaid Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "case rate", "standard_charge_dollar": 48564.2, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "UBH", "plan_name": "UBH Medicaid", "methodology": "case rate", "standard_charge_dollar": 48564.2, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicaid (02/01/2023 to 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 49535.48, "additional_payer_notes": "102% of State Medicaid Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicaid", "methodology": "case rate", "standard_charge_dollar": 48564.2, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup Medicaid", "methodology": "case rate", "standard_charge_dollar": 48564.2, "additional_payer_notes": "100% of State Medicaid Rates" } ] } ] }, { "description": "Hc Assay Of Procalcitonin", "code_information": [ { "code": "84145", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 96.63, "discounted_cash": 27.0, "minimum": 16.33, "maximum": 82.1355, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 57.71, "additional_payer_notes": "212.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medical Rental Network", "methodology": "fee schedule", "standard_charge_dollar": 57.71, "additional_payer_notes": "212.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 27.22, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "ALLY-ALIGN (FKA SPARTAN PLAN NJ, INC.)", "plan_name": "ALLY-ALIGN (FKA SPARTAN PLAN NJ, INC.)", "methodology": "fee schedule", "standard_charge_dollar": 28.58, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Americhoice (UHC)", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 27.22, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Amerihealth", "plan_name": "Amerihealth Medicare", "methodology": "fee schedule", "standard_charge_dollar": 27.22, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 39.47, "additional_payer_notes": "Laboratory - 145.00% of Medicare Rates" }, { "payer_name": "Clover Health", "plan_name": "Clover Medicare", "methodology": "fee schedule", "standard_charge_dollar": 27.22, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Coventry", "plan_name": "Coventry Auto", "methodology": "fee schedule", "standard_charge_dollar": 54.44, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Coventry", "plan_name": "Coventry Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 54.44, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "fee schedule", "standard_charge_dollar": 38.11, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Fairprice Healthcare Holdings", "plan_name": "Fairprice Healthcare Holdings", "methodology": "fee schedule", "standard_charge_dollar": 32.66, "additional_payer_notes": "Laboratory - 120.00% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ HMO POS", "methodology": "fee schedule", "standard_charge_dollar": 68.22, "additional_payer_notes": "177.30% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ Indemnity", "methodology": "fee schedule", "standard_charge_dollar": 68.22, "additional_payer_notes": "177.30% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ PPO", "methodology": "fee schedule", "standard_charge_dollar": 68.22, "additional_payer_notes": "177.30% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon Medicare", "methodology": "fee schedule", "standard_charge_dollar": 27.22, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Military Tricare", "methodology": "fee schedule", "standard_charge_dollar": 21.78, "additional_payer_notes": "80.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 27.22, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 27.22, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC All Payer (02-01-2023 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 16.33 }, { "payer_name": "UHC", "plan_name": "UHC Medicaid (02/01/2023 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 21.78 }, { "payer_name": "UHC", "plan_name": "UHC Oxford (02-01-2023 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 16.33 }, { "payer_name": "UHC - Adhoc", "plan_name": "UHC - Adhoc All Payer", "methodology": "fee schedule", "standard_charge_dollar": 27.22 }, { "payer_name": "UHC - Adhoc", "plan_name": "UHC - Adhoc Oxford", "methodology": "fee schedule", "standard_charge_dollar": 27.22 }, { "payer_name": "Wellcare", "plan_name": "Wellcare Insurance Exchange", "methodology": "fee schedule", "standard_charge_dollar": 36.75, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 27.22, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup Medicaid", "methodology": "percent of total billed charges", "standard_charge_percentage": 19.09, "median_amount": 18.02, "10th_percentile": 14.17, "90th_percentile": 27.22, "count": "15" }, { "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup Medicare", "methodology": "fee schedule", "standard_charge_dollar": 27.22, "additional_payer_notes": "100.00% of Medicare Rates" } ] } ] }, { "description": "Hc Immuniz Admin, Inj, Ea Ad Vac", "code_information": [ { "code": "90472", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 88.01, "minimum": 16.8011, "maximum": 74.8085, "payers_information": [ { "payer_name": "UHC", "plan_name": "UHC Medicaid (02/01/2023 to 12-31-2026)", "methodology": "percent of total billed charges", "standard_charge_percentage": 19.47, "median_amount": 16.74, "10th_percentile": 16.74, "90th_percentile": 16.74, "count": "1 through 10" } ] } ] }, { "description": "Cor Hlx Vlgs Dstl Mtar Osteo", "code_information": [ { "code": "28296", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 30292.5, "discounted_cash": 3868.0, "minimum": 1715.0, "maximum": 24234.0, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 8200.52, "additional_payer_notes": "212.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medical Rental Network", "methodology": "fee schedule", "standard_charge_dollar": 8200.52, "additional_payer_notes": "212.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3868.17, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "ALLY-ALIGN (FKA SPARTAN PLAN NJ, INC.)", "plan_name": "ALLY-ALIGN (FKA SPARTAN PLAN NJ, INC.)", "methodology": "fee schedule", "standard_charge_dollar": 4061.58, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Americhoice (UHC)", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3868.17, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Amerihealth", "plan_name": "Amerihealth Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3868.17, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 5684.28, "additional_payer_notes": "146.95% of Medicare Rates" }, { "payer_name": "Clover Health", "plan_name": "Clover Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3868.17, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Coventry", "plan_name": "Coventry Auto", "methodology": "fee schedule", "standard_charge_dollar": 7736.34, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Coventry", "plan_name": "Coventry Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 7736.34, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "fee schedule", "standard_charge_dollar": 5415.44, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Fairprice Healthcare Holdings", "plan_name": "Fairprice Healthcare Holdings", "methodology": "fee schedule", "standard_charge_dollar": 6189.07, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ HMO POS", "methodology": "fee schedule", "standard_charge_dollar": 6858.27, "additional_payer_notes": "177.30% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ Indemnity", "methodology": "fee schedule", "standard_charge_dollar": 6858.27, "additional_payer_notes": "177.30% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ PPO", "methodology": "fee schedule", "standard_charge_dollar": 6858.27, "additional_payer_notes": "177.30% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3868.17, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon NJ Health Medicaid", "methodology": "percent of total billed charges", "standard_charge_percentage": 19.58, "median_amount": 5083.95, "10th_percentile": 5083.95, "90th_percentile": 5083.95, "count": "1 through 10" }, { "payer_name": "Humana", "plan_name": "Humana Military Tricare", "methodology": "fee schedule", "standard_charge_dollar": 3094.54, "additional_payer_notes": "80.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3868.17, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 3868.17, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC All Payer (02-01-2023 to 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 5378.0 }, { "payer_name": "UHC", "plan_name": "UHC Oxford (02-01-2023 to 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 5169.0 }, { "payer_name": "UHC - Adhoc", "plan_name": "UHC - Adhoc All Payer", "methodology": "case rate", "standard_charge_dollar": 5709.0 }, { "payer_name": "UHC - Adhoc", "plan_name": "UHC - Adhoc Oxford", "methodology": "case rate", "standard_charge_dollar": 5327.0 }, { "payer_name": "Wellcare", "plan_name": "Wellcare Insurance Exchange", "methodology": "fee schedule", "standard_charge_dollar": 5222.03, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3868.17, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellchoice", "plan_name": "WELLCHOICE HMO of NJ (Empire) Commercial (HMO / HMO POS, PPO)", "methodology": "case rate", "standard_charge_dollar": 1715.0 }, { "payer_name": "Wellchoice", "plan_name": "WELLCHOICE HMO of NJ (Empire) Commercial (Indemnity)", "methodology": "case rate", "standard_charge_dollar": 1978.0 }, { "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3868.17, "additional_payer_notes": "100.00% of Medicare Rates" } ] } ] }, { "description": "Hc Venogram Sinus/Jugular", "code_information": [ { "code": "75860", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 13207.6, "discounted_cash": 3732.0, "minimum": 2521.3308, "maximum": 11226.46, "payers_information": [ { "payer_name": "Cigna", "plan_name": "Cigna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 5485.33, "additional_payer_notes": "146.95% of Medicare Rates" }, { "payer_name": "Clover Health", "plan_name": "Clover Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3732.79, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Coventry", "plan_name": "Coventry Auto", "methodology": "fee schedule", "standard_charge_dollar": 7465.58, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Coventry", "plan_name": "Coventry Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 7465.58, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "fee schedule", "standard_charge_dollar": 5225.91, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Fairprice Healthcare Holdings", "plan_name": "Fairprice Healthcare Holdings", "methodology": "fee schedule", "standard_charge_dollar": 5972.46, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ HMO POS", "methodology": "fee schedule", "standard_charge_dollar": 6618.24, "additional_payer_notes": "177.30% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ Indemnity", "methodology": "fee schedule", "standard_charge_dollar": 6618.24, "additional_payer_notes": "177.30% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ PPO", "methodology": "fee schedule", "standard_charge_dollar": 6618.24, "additional_payer_notes": "177.30% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3732.79, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Military Tricare", "methodology": "fee schedule", "standard_charge_dollar": 2986.23, "additional_payer_notes": "80.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3732.79, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 3732.79, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC All Payer (02-01-2023 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 4292.49 }, { "payer_name": "UHC", "plan_name": "UHC Oxford (02-01-2023 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 4292.49 }, { "payer_name": "UHC - Adhoc", "plan_name": "UHC - Adhoc All Payer", "methodology": "fee schedule", "standard_charge_dollar": 2861.66 }, { "payer_name": "UHC - Adhoc", "plan_name": "UHC - Adhoc Oxford", "methodology": "fee schedule", "standard_charge_dollar": 2861.66 }, { "payer_name": "Wellcare", "plan_name": "Wellcare Insurance Exchange", "methodology": "fee schedule", "standard_charge_dollar": 5039.27, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3732.79, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3732.79, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 7913.51, "additional_payer_notes": "212.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medical Rental Network", "methodology": "fee schedule", "standard_charge_dollar": 7913.51, "additional_payer_notes": "212.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3732.79, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "ALLY-ALIGN (FKA SPARTAN PLAN NJ, INC.)", "plan_name": "ALLY-ALIGN (FKA SPARTAN PLAN NJ, INC.)", "methodology": "fee schedule", "standard_charge_dollar": 3919.43, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Americhoice (UHC)", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3732.79, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Amerihealth", "plan_name": "Amerihealth Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3732.79, "additional_payer_notes": "100.00% of Medicare Rates" } ] } ] }, { "description": "BACK AND NECK PROCEDURES EXCEPT SPINAL FUSION WITH CC", "code_information": [ { "code": "519", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 24671.0, "minimum": 11626.95, "maximum": 44656.2657, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "case rate", "standard_charge_dollar": 44656.27, "additional_payer_notes": "181.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medical Rental Network", "methodology": "case rate", "standard_charge_dollar": 44656.27, "additional_payer_notes": "181.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "case rate", "standard_charge_dollar": 20117.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "ALLY-ALIGN (FKA SPARTAN PLAN NJ, INC.)", "plan_name": "ALLY-ALIGN (FKA SPARTAN PLAN NJ, INC.)", "methodology": "case rate", "standard_charge_dollar": 25905.57, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Americhoice (UHC)", "plan_name": "UHC Medicare", "methodology": "case rate", "standard_charge_dollar": 20117.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Amerihealth", "plan_name": "Amerihealth Medicare", "methodology": "case rate", "standard_charge_dollar": 20117.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Commercial", "methodology": "case rate", "standard_charge_dollar": 29262.93 }, { "payer_name": "Clover Health", "plan_name": "Clover Medicare", "methodology": "case rate", "standard_charge_dollar": 20117.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Coventry", "plan_name": "Coventry Auto", "methodology": "case rate", "standard_charge_dollar": 41942.35, "additional_payer_notes": "170.00% of Medicare Rates" }, { "payer_name": "Coventry", "plan_name": "Coventry Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 41942.35, "additional_payer_notes": "170.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "case rate", "standard_charge_dollar": 32073.56, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Fairprice Healthcare Holdings", "plan_name": "Fairprice Healthcare Holdings", "methodology": "case rate", "standard_charge_dollar": 39475.15, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon Medicare", "methodology": "case rate", "standard_charge_dollar": 20117.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon NJ Health Medicaid", "methodology": "case rate", "standard_charge_dollar": 11626.95 }, { "payer_name": "Humana", "plan_name": "Humana Military Tricare", "methodology": "case rate", "standard_charge_dollar": 19737.58, "additional_payer_notes": "80.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 24671.97, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 29209.2 }, { "payer_name": "UBH", "plan_name": "UBH Medicare", "methodology": "case rate", "standard_charge_dollar": 20117.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC All Payer (02-01-2023 to 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 33715.37 }, { "payer_name": "UHC", "plan_name": "UHC Oxford (02-01-2023 to 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 29382.94 }, { "payer_name": "UHC - Adhoc", "plan_name": "UHC - Adhoc All Payer", "methodology": "case rate", "standard_charge_dollar": 35789.58 }, { "payer_name": "UHC - Adhoc", "plan_name": "UHC - Adhoc Oxford", "methodology": "case rate", "standard_charge_dollar": 30279.03 }, { "payer_name": "Wellcare", "plan_name": "Wellcare Insurance Exchange", "methodology": "case rate", "standard_charge_dollar": 33307.16, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "case rate", "standard_charge_dollar": 20117.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup Medicare", "methodology": "case rate", "standard_charge_dollar": 20117.6, "additional_payer_notes": "100.00% of Medicare Rates" } ] } ] }, { "description": "Hc Ct Scan,Abdomen,W/O Contrast", "code_information": [ { "code": "74150", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 1541.0, "discounted_cash": 123.0, "minimum": 98.872, "maximum": 1309.85, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 262.01, "additional_payer_notes": "212.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medical Rental Network", "methodology": "fee schedule", "standard_charge_dollar": 262.01, "additional_payer_notes": "212.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 123.59, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "ALLY-ALIGN (FKA SPARTAN PLAN NJ, INC.)", "plan_name": "ALLY-ALIGN (FKA SPARTAN PLAN NJ, INC.)", "methodology": "fee schedule", "standard_charge_dollar": 129.77, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Americhoice (UHC)", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 123.59, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Amerihealth", "plan_name": "Amerihealth HMO", "methodology": "fee schedule", "standard_charge_dollar": 433.63 }, { "payer_name": "Amerihealth", "plan_name": "Amerihealth Medicare", "methodology": "fee schedule", "standard_charge_dollar": 123.59, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 181.62, "additional_payer_notes": "146.95% of Medicare Rates" }, { "payer_name": "Clover Health", "plan_name": "Clover Medicare", "methodology": "fee schedule", "standard_charge_dollar": 123.59, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Coventry", "plan_name": "Coventry Auto", "methodology": "fee schedule", "standard_charge_dollar": 247.18, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Coventry", "plan_name": "Coventry Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 247.18, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "fee schedule", "standard_charge_dollar": 173.03, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Fairprice Healthcare Holdings", "plan_name": "Fairprice Healthcare Holdings", "methodology": "fee schedule", "standard_charge_dollar": 197.74, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ HMO POS", "methodology": "fee schedule", "standard_charge_dollar": 219.13, "additional_payer_notes": "177.30% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ Indemnity", "methodology": "fee schedule", "standard_charge_dollar": 219.13, "additional_payer_notes": "177.30% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ PPO", "methodology": "fee schedule", "standard_charge_dollar": 219.13, "additional_payer_notes": "177.30% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon Medicare", "methodology": "fee schedule", "standard_charge_dollar": 123.59, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon NJ Health Medicaid", "methodology": "percent of total billed charges", "standard_charge_percentage": 19.58, "median_amount": 301.73, "10th_percentile": 301.73, "90th_percentile": 301.73, "count": "1 through 10" }, { "payer_name": "Humana", "plan_name": "Humana Military Tricare", "methodology": "fee schedule", "standard_charge_dollar": 98.87, "additional_payer_notes": "80.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 123.59, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 123.59, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC All Payer (02-01-2023 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 163.46 }, { "payer_name": "UHC", "plan_name": "UHC Oxford (02-01-2023 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 163.46 }, { "payer_name": "UHC - Adhoc", "plan_name": "UHC - Adhoc All Payer", "methodology": "fee schedule", "standard_charge_dollar": 108.97 }, { "payer_name": "UHC - Adhoc", "plan_name": "UHC - Adhoc Oxford", "methodology": "fee schedule", "standard_charge_dollar": 108.97 }, { "payer_name": "Wellcare", "plan_name": "Wellcare Insurance Exchange", "methodology": "fee schedule", "standard_charge_dollar": 166.85, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 123.59, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup Medicare", "methodology": "fee schedule", "standard_charge_dollar": 123.59, "additional_payer_notes": "100.00% of Medicare Rates" } ] } ] }, { "description": "TESTES PROCEDURES WITHOUT CCMCC", "code_information": [ { "code": "712", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 14265.0, "minimum": 6723.9, "maximum": 25820.3197, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "case rate", "standard_charge_dollar": 25820.32, "additional_payer_notes": "181.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medical Rental Network", "methodology": "case rate", "standard_charge_dollar": 25820.32, "additional_payer_notes": "181.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "case rate", "standard_charge_dollar": 11761.4, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "ALLY-ALIGN (FKA SPARTAN PLAN NJ, INC.)", "plan_name": "ALLY-ALIGN (FKA SPARTAN PLAN NJ, INC.)", "methodology": "case rate", "standard_charge_dollar": 14978.64, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Americhoice (UHC)", "plan_name": "UHC Medicare", "methodology": "case rate", "standard_charge_dollar": 11761.4, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Amerihealth", "plan_name": "Amerihealth Medicare", "methodology": "case rate", "standard_charge_dollar": 11761.4, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Commercial", "methodology": "case rate", "standard_charge_dollar": 16088.61 }, { "payer_name": "Clover Health", "plan_name": "Clover Medicare", "methodology": "case rate", "standard_charge_dollar": 11761.4, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Coventry", "plan_name": "Coventry Auto", "methodology": "case rate", "standard_charge_dollar": 24251.13, "additional_payer_notes": "170.00% of Medicare Rates" }, { "payer_name": "Coventry", "plan_name": "Coventry Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 24251.13, "additional_payer_notes": "170.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "case rate", "standard_charge_dollar": 18544.98, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Fairprice Healthcare Holdings", "plan_name": "Fairprice Healthcare Holdings", "methodology": "case rate", "standard_charge_dollar": 22824.59, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon Medicare", "methodology": "case rate", "standard_charge_dollar": 11761.4, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon NJ Health Medicaid", "methodology": "case rate", "standard_charge_dollar": 6723.9 }, { "payer_name": "Humana", "plan_name": "Humana Military Tricare", "methodology": "case rate", "standard_charge_dollar": 11412.3, "additional_payer_notes": "80.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 14265.37, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 13640.6 }, { "payer_name": "UBH", "plan_name": "UBH Medicare", "methodology": "case rate", "standard_charge_dollar": 11761.4, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC All Payer (02-01-2023 to 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 18536.54 }, { "payer_name": "UHC", "plan_name": "UHC Oxford (02-01-2023 to 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 16154.59 }, { "payer_name": "UHC - Adhoc", "plan_name": "UHC - Adhoc All Payer", "methodology": "case rate", "standard_charge_dollar": 19676.93 }, { "payer_name": "UHC - Adhoc", "plan_name": "UHC - Adhoc Oxford", "methodology": "case rate", "standard_charge_dollar": 16647.26 }, { "payer_name": "Wellcare", "plan_name": "Wellcare Insurance Exchange", "methodology": "case rate", "standard_charge_dollar": 19258.25, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "case rate", "standard_charge_dollar": 11761.4, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup Medicare", "methodology": "case rate", "standard_charge_dollar": 11761.4, "additional_payer_notes": "100.00% of Medicare Rates" } ] } ] }, { "description": "Hc Bronchoscopy Diag W Lung Bx, Single Lobe", "code_information": [ { "code": "31628", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 400.0, "discounted_cash": 4407.0, "minimum": 76.36, "maximum": 400.0, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 400.0, "additional_payer_notes": "212.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medical Rental Network", "methodology": "fee schedule", "standard_charge_dollar": 400.0, "additional_payer_notes": "212.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 400.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "ALLY-ALIGN (FKA SPARTAN PLAN NJ, INC.)", "plan_name": "ALLY-ALIGN (FKA SPARTAN PLAN NJ, INC.)", "methodology": "fee schedule", "standard_charge_dollar": 400.0, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Americhoice (UHC)", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 400.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Amerihealth", "plan_name": "Amerihealth Medicare", "methodology": "fee schedule", "standard_charge_dollar": 400.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 400.0, "additional_payer_notes": "146.95% of Medicare Rates" }, { "payer_name": "Clover Health", "plan_name": "Clover Medicare", "methodology": "fee schedule", "standard_charge_dollar": 400.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Coventry", "plan_name": "Coventry Auto", "methodology": "fee schedule", "standard_charge_dollar": 400.0, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Coventry", "plan_name": "Coventry Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 400.0, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "fee schedule", "standard_charge_dollar": 400.0, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Fairprice Healthcare Holdings", "plan_name": "Fairprice Healthcare Holdings", "methodology": "fee schedule", "standard_charge_dollar": 400.0, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ HMO POS", "methodology": "fee schedule", "standard_charge_dollar": 400.0, "additional_payer_notes": "177.30% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ Indemnity", "methodology": "fee schedule", "standard_charge_dollar": 400.0, "additional_payer_notes": "177.30% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ PPO", "methodology": "fee schedule", "standard_charge_dollar": 400.0, "additional_payer_notes": "177.30% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon Medicare", "methodology": "fee schedule", "standard_charge_dollar": 400.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Military Tricare", "methodology": "fee schedule", "standard_charge_dollar": 400.0, "additional_payer_notes": "80.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 400.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 400.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC All Payer (02-01-2023 to 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 400.0 }, { "payer_name": "UHC", "plan_name": "UHC Oxford (02-01-2023 to 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 400.0 }, { "payer_name": "UHC - Adhoc", "plan_name": "UHC - Adhoc All Payer", "methodology": "case rate", "standard_charge_dollar": 400.0 }, { "payer_name": "UHC - Adhoc", "plan_name": "UHC - Adhoc Oxford", "methodology": "case rate", "standard_charge_dollar": 400.0 }, { "payer_name": "Wellcare", "plan_name": "Wellcare Insurance Exchange", "methodology": "fee schedule", "standard_charge_dollar": 400.0, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 400.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellchoice", "plan_name": "WELLCHOICE HMO of NJ (Empire) Commercial (HMO / HMO POS, PPO)", "methodology": "case rate", "standard_charge_dollar": 400.0 }, { "payer_name": "Wellchoice", "plan_name": "WELLCHOICE HMO of NJ (Empire) Commercial (Indemnity)", "methodology": "case rate", "standard_charge_dollar": 400.0 }, { "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup Medicare", "methodology": "fee schedule", "standard_charge_dollar": 400.0, "additional_payer_notes": "100.00% of Medicare Rates" } ] } ] }, { "description": "Hc I&D Below Fascia Foot, Multiple", "code_information": [ { "code": "28003", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 15420.2, "discounted_cash": 3868.0, "minimum": 1715.0, "maximum": 12336.16, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 8200.52, "additional_payer_notes": "212.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medical Rental Network", "methodology": "fee schedule", "standard_charge_dollar": 8200.52, "additional_payer_notes": "212.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3868.17, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "ALLY-ALIGN (FKA SPARTAN PLAN NJ, INC.)", "plan_name": "ALLY-ALIGN (FKA SPARTAN PLAN NJ, INC.)", "methodology": "fee schedule", "standard_charge_dollar": 4061.58, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Americhoice (UHC)", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3868.17, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Amerihealth", "plan_name": "Amerihealth Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3868.17, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 5684.28, "additional_payer_notes": "146.95% of Medicare Rates" }, { "payer_name": "Clover Health", "plan_name": "Clover Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3868.17, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Coventry", "plan_name": "Coventry Auto", "methodology": "fee schedule", "standard_charge_dollar": 7736.34, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Coventry", "plan_name": "Coventry Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 7736.34, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "fee schedule", "standard_charge_dollar": 5415.44, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Fairprice Healthcare Holdings", "plan_name": "Fairprice Healthcare Holdings", "methodology": "fee schedule", "standard_charge_dollar": 6189.07, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ HMO POS", "methodology": "fee schedule", "standard_charge_dollar": 6858.27, "additional_payer_notes": "177.30% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ Indemnity", "methodology": "fee schedule", "standard_charge_dollar": 6858.27, "additional_payer_notes": "177.30% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ PPO", "methodology": "fee schedule", "standard_charge_dollar": 6858.27, "additional_payer_notes": "177.30% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3868.17, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Military Tricare", "methodology": "fee schedule", "standard_charge_dollar": 3094.54, "additional_payer_notes": "80.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3868.17, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 3868.17, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC All Payer (02-01-2023 to 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 4415.0 }, { "payer_name": "UHC", "plan_name": "UHC Oxford (02-01-2023 to 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 4020.0 }, { "payer_name": "UHC - Adhoc", "plan_name": "UHC - Adhoc All Payer", "methodology": "case rate", "standard_charge_dollar": 4687.0 }, { "payer_name": "UHC - Adhoc", "plan_name": "UHC - Adhoc Oxford", "methodology": "case rate", "standard_charge_dollar": 4143.0 }, { "payer_name": "Wellcare", "plan_name": "Wellcare Insurance Exchange", "methodology": "fee schedule", "standard_charge_dollar": 5222.03, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3868.17, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellchoice", "plan_name": "WELLCHOICE HMO of NJ (Empire) Commercial (HMO / HMO POS, PPO)", "methodology": "case rate", "standard_charge_dollar": 1715.0 }, { "payer_name": "Wellchoice", "plan_name": "WELLCHOICE HMO of NJ (Empire) Commercial (Indemnity)", "methodology": "case rate", "standard_charge_dollar": 1978.0 }, { "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3868.17, "additional_payer_notes": "100.00% of Medicare Rates" } ] } ] }, { "description": "ANAL AND STOMAL PROCEDURES WITH MCC", "code_information": [ { "code": "347", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 28085.0, "minimum": 15055.71, "maximum": 50835.2075, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "case rate", "standard_charge_dollar": 50835.21, "additional_payer_notes": "181.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medical Rental Network", "methodology": "case rate", "standard_charge_dollar": 50835.21, "additional_payer_notes": "181.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "case rate", "standard_charge_dollar": 22858.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "ALLY-ALIGN (FKA SPARTAN PLAN NJ, INC.)", "plan_name": "ALLY-ALIGN (FKA SPARTAN PLAN NJ, INC.)", "methodology": "case rate", "standard_charge_dollar": 29490.04, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Americhoice (UHC)", "plan_name": "UHC Medicare", "methodology": "case rate", "standard_charge_dollar": 22858.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Amerihealth", "plan_name": "Amerihealth Medicare", "methodology": "case rate", "standard_charge_dollar": 22858.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Commercial", "methodology": "case rate", "standard_charge_dollar": 33584.63 }, { "payer_name": "Clover Health", "plan_name": "Clover Medicare", "methodology": "case rate", "standard_charge_dollar": 22858.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Coventry", "plan_name": "Coventry Auto", "methodology": "case rate", "standard_charge_dollar": 47745.78, "additional_payer_notes": "170.00% of Medicare Rates" }, { "payer_name": "Coventry", "plan_name": "Coventry Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 47745.78, "additional_payer_notes": "170.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "case rate", "standard_charge_dollar": 36511.48, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Fairprice Healthcare Holdings", "plan_name": "Fairprice Healthcare Holdings", "methodology": "case rate", "standard_charge_dollar": 44937.2, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon Medicare", "methodology": "case rate", "standard_charge_dollar": 22858.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon NJ Health Medicaid", "methodology": "case rate", "standard_charge_dollar": 15055.71 }, { "payer_name": "Humana", "plan_name": "Humana Military Tricare", "methodology": "case rate", "standard_charge_dollar": 22468.6, "additional_payer_notes": "80.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 28085.75, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 34433.7 }, { "payer_name": "UBH", "plan_name": "UBH Medicare", "methodology": "case rate", "standard_charge_dollar": 22858.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC All Payer (02-01-2023 to 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 38694.63 }, { "payer_name": "UHC", "plan_name": "UHC Oxford (02-01-2023 to 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 33722.36 }, { "payer_name": "UHC - Adhoc", "plan_name": "UHC - Adhoc All Payer", "methodology": "case rate", "standard_charge_dollar": 41075.17 }, { "payer_name": "UHC - Adhoc", "plan_name": "UHC - Adhoc Oxford", "methodology": "case rate", "standard_charge_dollar": 34750.79 }, { "payer_name": "Wellcare", "plan_name": "Wellcare Insurance Exchange", "methodology": "case rate", "standard_charge_dollar": 37915.76, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "case rate", "standard_charge_dollar": 22858.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup Medicare", "methodology": "case rate", "standard_charge_dollar": 22858.8, "additional_payer_notes": "100.00% of Medicare Rates" } ] } ] }, { "description": "Hc Oncoprotein Dcp", "code_information": [ { "code": "83951", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 331.0, "discounted_cash": 64.0, "minimum": 38.65, "maximum": 281.35, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 136.55, "additional_payer_notes": "212.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medical Rental Network", "methodology": "fee schedule", "standard_charge_dollar": 136.55, "additional_payer_notes": "212.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 64.41, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "ALLY-ALIGN (FKA SPARTAN PLAN NJ, INC.)", "plan_name": "ALLY-ALIGN (FKA SPARTAN PLAN NJ, INC.)", "methodology": "fee schedule", "standard_charge_dollar": 67.63, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Americhoice (UHC)", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 64.41, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Amerihealth", "plan_name": "Amerihealth Medicare", "methodology": "fee schedule", "standard_charge_dollar": 64.41, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 93.39, "additional_payer_notes": "Laboratory - 145.00% of Medicare Rates" }, { "payer_name": "Clover Health", "plan_name": "Clover Medicare", "methodology": "fee schedule", "standard_charge_dollar": 64.41, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Coventry", "plan_name": "Coventry Auto", "methodology": "fee schedule", "standard_charge_dollar": 128.82, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Coventry", "plan_name": "Coventry Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 128.82, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "fee schedule", "standard_charge_dollar": 90.17, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Fairprice Healthcare Holdings", "plan_name": "Fairprice Healthcare Holdings", "methodology": "fee schedule", "standard_charge_dollar": 77.29, "additional_payer_notes": "Laboratory - 120.00% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ HMO POS", "methodology": "fee schedule", "standard_charge_dollar": 233.69, "additional_payer_notes": "177.30% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ Indemnity", "methodology": "fee schedule", "standard_charge_dollar": 233.69, "additional_payer_notes": "177.30% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ PPO", "methodology": "fee schedule", "standard_charge_dollar": 233.69, "additional_payer_notes": "177.30% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon Medicare", "methodology": "fee schedule", "standard_charge_dollar": 64.41, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Military Tricare", "methodology": "fee schedule", "standard_charge_dollar": 51.53, "additional_payer_notes": "80.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 64.41, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 64.41, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC All Payer (02-01-2023 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 38.65 }, { "payer_name": "UHC", "plan_name": "UHC Medicaid (02/01/2023 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 51.53 }, { "payer_name": "UHC", "plan_name": "UHC Oxford (02-01-2023 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 38.65 }, { "payer_name": "UHC - Adhoc", "plan_name": "UHC - Adhoc All Payer", "methodology": "fee schedule", "standard_charge_dollar": 64.41 }, { "payer_name": "UHC - Adhoc", "plan_name": "UHC - Adhoc Oxford", "methodology": "fee schedule", "standard_charge_dollar": 64.41 }, { "payer_name": "Wellcare", "plan_name": "Wellcare Insurance Exchange", "methodology": "fee schedule", "standard_charge_dollar": 86.95, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 64.41, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup Medicare", "methodology": "fee schedule", "standard_charge_dollar": 64.41, "additional_payer_notes": "100.00% of Medicare Rates" } ] } ] }, { "description": "Reconstruction knee", "code_information": [ { "code": "27427", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 29446.5, "discounted_cash": 8578.0, "minimum": 1715.0, "maximum": 23557.2, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 18186.06, "additional_payer_notes": "212.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medical Rental Network", "methodology": "fee schedule", "standard_charge_dollar": 18186.06, "additional_payer_notes": "212.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 8578.33, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "ALLY-ALIGN (FKA SPARTAN PLAN NJ, INC.)", "plan_name": "ALLY-ALIGN (FKA SPARTAN PLAN NJ, INC.)", "methodology": "fee schedule", "standard_charge_dollar": 9007.25, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Americhoice (UHC)", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 8578.33, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Amerihealth", "plan_name": "Amerihealth Medicare", "methodology": "fee schedule", "standard_charge_dollar": 8578.33, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 12605.86, "additional_payer_notes": "146.95% of Medicare Rates" }, { "payer_name": "Clover Health", "plan_name": "Clover Medicare", "methodology": "fee schedule", "standard_charge_dollar": 8578.33, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Coventry", "plan_name": "Coventry Auto", "methodology": "fee schedule", "standard_charge_dollar": 17156.66, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Coventry", "plan_name": "Coventry Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 17156.66, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "fee schedule", "standard_charge_dollar": 12009.66, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Fairprice Healthcare Holdings", "plan_name": "Fairprice Healthcare Holdings", "methodology": "fee schedule", "standard_charge_dollar": 13725.33, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ HMO POS", "methodology": "fee schedule", "standard_charge_dollar": 15209.38, "additional_payer_notes": "177.30% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ Indemnity", "methodology": "fee schedule", "standard_charge_dollar": 15209.38, "additional_payer_notes": "177.30% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ PPO", "methodology": "fee schedule", "standard_charge_dollar": 15209.38, "additional_payer_notes": "177.30% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon Medicare", "methodology": "fee schedule", "standard_charge_dollar": 8578.33, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Military Tricare", "methodology": "fee schedule", "standard_charge_dollar": 6862.66, "additional_payer_notes": "80.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 8578.33, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 8578.33, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC All Payer (02-01-2023 to 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 6624.0 }, { "payer_name": "UHC", "plan_name": "UHC Oxford (02-01-2023 to 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 6317.0 }, { "payer_name": "UHC - Adhoc", "plan_name": "UHC - Adhoc All Payer", "methodology": "case rate", "standard_charge_dollar": 7031.0 }, { "payer_name": "UHC - Adhoc", "plan_name": "UHC - Adhoc Oxford", "methodology": "case rate", "standard_charge_dollar": 6510.0 }, { "payer_name": "Wellcare", "plan_name": "Wellcare Insurance Exchange", "methodology": "fee schedule", "standard_charge_dollar": 11580.75, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 8578.33, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellchoice", "plan_name": "WELLCHOICE HMO of NJ (Empire) Commercial (HMO / HMO POS, PPO)", "methodology": "case rate", "standard_charge_dollar": 1715.0 }, { "payer_name": "Wellchoice", "plan_name": "WELLCHOICE HMO of NJ (Empire) Commercial (Indemnity)", "methodology": "case rate", "standard_charge_dollar": 1978.0 }, { "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup Medicare", "methodology": "fee schedule", "standard_charge_dollar": 8578.33, "additional_payer_notes": "100.00% of Medicare Rates" } ] } ] }, { "description": "Unlstd laps px abd pertm&omn", "code_information": [ { "code": "49329", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 14992.15, "discounted_cash": 7147.0, "minimum": 1715.0, "maximum": 14992.15, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 14992.15, "additional_payer_notes": "212.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medical Rental Network", "methodology": "fee schedule", "standard_charge_dollar": 14992.15, "additional_payer_notes": "212.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 7147.05, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "ALLY-ALIGN (FKA SPARTAN PLAN NJ, INC.)", "plan_name": "ALLY-ALIGN (FKA SPARTAN PLAN NJ, INC.)", "methodology": "fee schedule", "standard_charge_dollar": 7504.4, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Americhoice (UHC)", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 7147.05, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Amerihealth", "plan_name": "Amerihealth Medicare", "methodology": "fee schedule", "standard_charge_dollar": 7147.05, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 10502.59, "additional_payer_notes": "146.95% of Medicare Rates" }, { "payer_name": "Clover Health", "plan_name": "Clover Medicare", "methodology": "fee schedule", "standard_charge_dollar": 7147.05, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Coventry", "plan_name": "Coventry Auto", "methodology": "fee schedule", "standard_charge_dollar": 14294.1, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Coventry", "plan_name": "Coventry Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 14294.1, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "fee schedule", "standard_charge_dollar": 10005.87, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Fairprice Healthcare Holdings", "plan_name": "Fairprice Healthcare Holdings", "methodology": "fee schedule", "standard_charge_dollar": 11435.28, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ HMO POS", "methodology": "fee schedule", "standard_charge_dollar": 12671.72, "additional_payer_notes": "177.30% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ Indemnity", "methodology": "fee schedule", "standard_charge_dollar": 12671.72, "additional_payer_notes": "177.30% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ PPO", "methodology": "fee schedule", "standard_charge_dollar": 12671.72, "additional_payer_notes": "177.30% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon Medicare", "methodology": "fee schedule", "standard_charge_dollar": 7147.05, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon NJ Health Medicaid", "methodology": "percent of total billed charges", "standard_charge_percentage": 19.58, "median_amount": 2118.31, "10th_percentile": 2118.31, "90th_percentile": 2118.31, "count": "1 through 10" }, { "payer_name": "Humana", "plan_name": "Humana Military Tricare", "methodology": "fee schedule", "standard_charge_dollar": 5717.64, "additional_payer_notes": "80.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 7147.05, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 7147.05, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC All Payer (02-01-2023 to 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 5667.0 }, { "payer_name": "UHC", "plan_name": "UHC Oxford (02-01-2023 to 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 5169.0 }, { "payer_name": "UHC - Adhoc", "plan_name": "UHC - Adhoc All Payer", "methodology": "case rate", "standard_charge_dollar": 6016.0 }, { "payer_name": "UHC - Adhoc", "plan_name": "UHC - Adhoc Oxford", "methodology": "case rate", "standard_charge_dollar": 5327.0 }, { "payer_name": "Wellcare", "plan_name": "Wellcare Insurance Exchange", "methodology": "fee schedule", "standard_charge_dollar": 9648.52, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 7147.05, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellchoice", "plan_name": "WELLCHOICE HMO of NJ (Empire) Commercial (HMO / HMO POS, PPO)", "methodology": "case rate", "standard_charge_dollar": 1715.0 }, { "payer_name": "Wellchoice", "plan_name": "WELLCHOICE HMO of NJ (Empire) Commercial (Indemnity)", "methodology": "case rate", "standard_charge_dollar": 1978.0 }, { "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup Medicaid", "methodology": "percent of total billed charges", "standard_charge_percentage": 19.09, "median_amount": 3228.32, "10th_percentile": 3228.32, "90th_percentile": 3228.32, "count": "1 through 10" }, { "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup Medicare", "methodology": "fee schedule", "standard_charge_dollar": 7147.05, "additional_payer_notes": "100.00% of Medicare Rates" } ] } ] }, { "description": "OTHER KIDNEY, URINARY TRACT & RELATED PROCEDURES - SOI : 3", "code_information": [ { "code": "4473", "type": "APR-DRG" } ], "standard_charges": [ { "setting": "inpatient", "minimum": 25899.2, "maximum": 28489.12, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Better Health - Medi Medi", "methodology": "case rate", "standard_charge_dollar": 28489.12, "additional_payer_notes": "110% of State Medicaid Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Better Health Medicaid", "methodology": "case rate", "standard_charge_dollar": 28489.12, "additional_payer_notes": "110% of State Medicaid Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "case rate", "standard_charge_dollar": 25899.2, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "UBH", "plan_name": "UBH Medicaid", "methodology": "case rate", "standard_charge_dollar": 25899.2, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicaid (02/01/2023 to 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 26417.18, "additional_payer_notes": "102% of State Medicaid Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicaid", "methodology": "case rate", "standard_charge_dollar": 25899.2, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup Medicaid", "methodology": "case rate", "standard_charge_dollar": 25899.2, "additional_payer_notes": "100% of State Medicaid Rates" } ] } ] }, { "description": "CONCUSSION, CLOSED SKULL FX NOS,UNCOMPLICATED INTRACRANIAL INJURY, COMA < 1 HR OR NO COMA - SOI : 4", "code_information": [ { "code": "0574", "type": "APR-DRG" } ], "standard_charges": [ { "setting": "inpatient", "minimum": 23502.88, "maximum": 25853.17, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Better Health - Medi Medi", "methodology": "case rate", "standard_charge_dollar": 25853.17, "additional_payer_notes": "110% of State Medicaid Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Better Health Medicaid", "methodology": "case rate", "standard_charge_dollar": 25853.17, "additional_payer_notes": "110% of State Medicaid Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "case rate", "standard_charge_dollar": 23502.88, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "UBH", "plan_name": "UBH Medicaid", "methodology": "case rate", "standard_charge_dollar": 23502.88, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicaid (02/01/2023 to 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 23972.94, "additional_payer_notes": "102% of State Medicaid Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicaid", "methodology": "case rate", "standard_charge_dollar": 23502.88, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup Medicaid", "methodology": "case rate", "standard_charge_dollar": 23502.88, "additional_payer_notes": "100% of State Medicaid Rates" } ] } ] }, { "description": "Hc Duplex Extrem Venous,Uni Or Ltd", "code_information": [ { "code": "93971", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 850.0, "discounted_cash": 123.0, "minimum": 98.872, "maximum": 850.0, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 262.01, "additional_payer_notes": "212.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medical Rental Network", "methodology": "fee schedule", "standard_charge_dollar": 262.01, "additional_payer_notes": "212.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 123.59, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "ALLY-ALIGN (FKA SPARTAN PLAN NJ, INC.)", "plan_name": "ALLY-ALIGN (FKA SPARTAN PLAN NJ, INC.)", "methodology": "fee schedule", "standard_charge_dollar": 129.77, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Americhoice (UHC)", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 123.59, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Amerihealth", "plan_name": "Amerihealth Medicare", "methodology": "fee schedule", "standard_charge_dollar": 123.59, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 181.62, "additional_payer_notes": "146.95% of Medicare Rates" }, { "payer_name": "Clover Health", "plan_name": "Clover Medicare", "methodology": "fee schedule", "standard_charge_dollar": 123.59, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Coventry", "plan_name": "Coventry Auto", "methodology": "fee schedule", "standard_charge_dollar": 247.18, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Coventry", "plan_name": "Coventry Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 247.18, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "fee schedule", "standard_charge_dollar": 173.03, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Fairprice Healthcare Holdings", "plan_name": "Fairprice Healthcare Holdings", "methodology": "fee schedule", "standard_charge_dollar": 197.74, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ HMO POS", "methodology": "fee schedule", "standard_charge_dollar": 219.13, "additional_payer_notes": "177.30% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ Indemnity", "methodology": "fee schedule", "standard_charge_dollar": 219.13, "additional_payer_notes": "177.30% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ PPO", "methodology": "fee schedule", "standard_charge_dollar": 219.13, "additional_payer_notes": "177.30% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon Medicare", "methodology": "fee schedule", "standard_charge_dollar": 123.59, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon NJ Health Medicaid", "methodology": "percent of total billed charges", "standard_charge_percentage": 19.58, "median_amount": 166.43, "10th_percentile": 166.43, "90th_percentile": 166.43, "count": "27" }, { "payer_name": "Humana", "plan_name": "Humana Military Tricare", "methodology": "fee schedule", "standard_charge_dollar": 98.87, "additional_payer_notes": "80.00% of Medicare Rates" }, { "payer_name": "Keenan", "plan_name": "Keenan", "methodology": "percent of total billed charges", "standard_charge_percentage": 30.0, "median_amount": 255.0, "10th_percentile": 255.0, "90th_percentile": 255.0, "count": "1 through 10" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 123.59, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 123.59, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC All Payer (02-01-2023 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 850.0 }, { "payer_name": "UHC", "plan_name": "UHC Medicaid (02/01/2023 to 12-31-2026)", "methodology": "percent of total billed charges", "standard_charge_percentage": 19.47, "median_amount": 161.7, "10th_percentile": 125.23, "90th_percentile": 165.52, "count": "11" }, { "payer_name": "UHC", "plan_name": "UHC Oxford (02-01-2023 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 850.0 }, { "payer_name": "UHC - Adhoc", "plan_name": "UHC - Adhoc All Payer", "methodology": "fee schedule", "standard_charge_dollar": 850.0 }, { "payer_name": "UHC - Adhoc", "plan_name": "UHC - Adhoc Oxford", "methodology": "fee schedule", "standard_charge_dollar": 850.0 }, { "payer_name": "Wellcare", "plan_name": "Wellcare Insurance Exchange", "methodology": "fee schedule", "standard_charge_dollar": 166.85, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 123.59, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup Medicaid", "methodology": "percent of total billed charges", "standard_charge_percentage": 19.09, "median_amount": 158.53, "10th_percentile": 158.53, "90th_percentile": 158.53, "count": "1 through 10" }, { "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup Medicare", "methodology": "fee schedule", "standard_charge_dollar": 123.59, "additional_payer_notes": "100.00% of Medicare Rates" } ] } ] }, { "description": "Hc Interrogation Eval F2F 1/Dual/Mlt Leads Cvdfb", "code_information": [ { "code": "93289", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 1000.0, "discounted_cash": 44.0, "minimum": 35.288, "maximum": 1000.0, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 93.51, "additional_payer_notes": "212.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medical Rental Network", "methodology": "fee schedule", "standard_charge_dollar": 93.51, "additional_payer_notes": "212.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 44.11, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "ALLY-ALIGN (FKA SPARTAN PLAN NJ, INC.)", "plan_name": "ALLY-ALIGN (FKA SPARTAN PLAN NJ, INC.)", "methodology": "fee schedule", "standard_charge_dollar": 46.32, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Americhoice (UHC)", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 44.11, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Amerihealth", "plan_name": "Amerihealth Medicare", "methodology": "fee schedule", "standard_charge_dollar": 44.11, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 64.82, "additional_payer_notes": "146.95% of Medicare Rates" }, { "payer_name": "Clover Health", "plan_name": "Clover Medicare", "methodology": "fee schedule", "standard_charge_dollar": 44.11, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Coventry", "plan_name": "Coventry Auto", "methodology": "fee schedule", "standard_charge_dollar": 88.22, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Coventry", "plan_name": "Coventry Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 88.22, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "fee schedule", "standard_charge_dollar": 61.75, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Fairprice Healthcare Holdings", "plan_name": "Fairprice Healthcare Holdings", "methodology": "fee schedule", "standard_charge_dollar": 70.58, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ HMO POS", "methodology": "fee schedule", "standard_charge_dollar": 78.21, "additional_payer_notes": "177.30% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ Indemnity", "methodology": "fee schedule", "standard_charge_dollar": 78.21, "additional_payer_notes": "177.30% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ PPO", "methodology": "fee schedule", "standard_charge_dollar": 78.21, "additional_payer_notes": "177.30% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon Medicare", "methodology": "fee schedule", "standard_charge_dollar": 44.11, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Military Tricare", "methodology": "fee schedule", "standard_charge_dollar": 35.29, "additional_payer_notes": "80.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 44.11, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 44.11, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC All Payer (02-01-2023 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 1000.0 }, { "payer_name": "UHC", "plan_name": "UHC Oxford (02-01-2023 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 1000.0 }, { "payer_name": "UHC - Adhoc", "plan_name": "UHC - Adhoc All Payer", "methodology": "fee schedule", "standard_charge_dollar": 1000.0 }, { "payer_name": "UHC - Adhoc", "plan_name": "UHC - Adhoc Oxford", "methodology": "fee schedule", "standard_charge_dollar": 1000.0 }, { "payer_name": "Wellcare", "plan_name": "Wellcare Insurance Exchange", "methodology": "fee schedule", "standard_charge_dollar": 59.55, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 44.11, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellchoice", "plan_name": "WELLCHOICE HMO of NJ (Empire) Commercial (HMO / HMO POS, PPO)", "methodology": "case rate", "standard_charge_dollar": 1000.0 }, { "payer_name": "Wellchoice", "plan_name": "WELLCHOICE HMO of NJ (Empire) Commercial (Indemnity)", "methodology": "case rate", "standard_charge_dollar": 1000.0 }, { "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup Medicare", "methodology": "fee schedule", "standard_charge_dollar": 44.11, "additional_payer_notes": "100.00% of Medicare Rates" } ] } ] }, { "description": "Incision Of Tendon Sheath", "code_information": [ { "code": "25000", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 15437.6, "discounted_cash": 1900.0, "minimum": 1520.776, "maximum": 12350.08, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 4030.06, "additional_payer_notes": "212.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medical Rental Network", "methodology": "fee schedule", "standard_charge_dollar": 4030.06, "additional_payer_notes": "212.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1900.97, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "ALLY-ALIGN (FKA SPARTAN PLAN NJ, INC.)", "plan_name": "ALLY-ALIGN (FKA SPARTAN PLAN NJ, INC.)", "methodology": "fee schedule", "standard_charge_dollar": 1996.02, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Americhoice (UHC)", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1900.97, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Amerihealth", "plan_name": "Amerihealth Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1900.97, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 2793.48, "additional_payer_notes": "146.95% of Medicare Rates" }, { "payer_name": "Clover Health", "plan_name": "Clover Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1900.97, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Coventry", "plan_name": "Coventry Auto", "methodology": "fee schedule", "standard_charge_dollar": 3801.94, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Coventry", "plan_name": "Coventry Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 3801.94, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "fee schedule", "standard_charge_dollar": 2661.36, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Fairprice Healthcare Holdings", "plan_name": "Fairprice Healthcare Holdings", "methodology": "fee schedule", "standard_charge_dollar": 3041.55, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ HMO POS", "methodology": "fee schedule", "standard_charge_dollar": 3370.42, "additional_payer_notes": "177.30% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ Indemnity", "methodology": "fee schedule", "standard_charge_dollar": 3370.42, "additional_payer_notes": "177.30% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ PPO", "methodology": "fee schedule", "standard_charge_dollar": 3370.42, "additional_payer_notes": "177.30% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1900.97, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Military Tricare", "methodology": "fee schedule", "standard_charge_dollar": 1520.78, "additional_payer_notes": "80.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1900.97, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 1900.97, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC All Payer (02-01-2023 to 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 4415.0 }, { "payer_name": "UHC", "plan_name": "UHC Oxford (02-01-2023 to 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 4020.0 }, { "payer_name": "UHC - Adhoc", "plan_name": "UHC - Adhoc All Payer", "methodology": "case rate", "standard_charge_dollar": 4687.0 }, { "payer_name": "UHC - Adhoc", "plan_name": "UHC - Adhoc Oxford", "methodology": "case rate", "standard_charge_dollar": 4143.0 }, { "payer_name": "Wellcare", "plan_name": "Wellcare Insurance Exchange", "methodology": "fee schedule", "standard_charge_dollar": 2566.31, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1900.97, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellchoice", "plan_name": "WELLCHOICE HMO of NJ (Empire) Commercial (HMO / HMO POS, PPO)", "methodology": "case rate", "standard_charge_dollar": 1715.0 }, { "payer_name": "Wellchoice", "plan_name": "WELLCHOICE HMO of NJ (Empire) Commercial (Indemnity)", "methodology": "case rate", "standard_charge_dollar": 1978.0 }, { "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1900.97, "additional_payer_notes": "100.00% of Medicare Rates" } ] } ] }, { "description": "Hc Colorectal Cancer Scrn, Colonoscopy Not High Risk - 45378 - 75000071", "code_information": [ { "code": "45378", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 3752.03, "discounted_cash": 1099.0, "minimum": 716.2625, "maximum": 3752.03, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 2330.73, "additional_payer_notes": "212.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medical Rental Network", "methodology": "fee schedule", "standard_charge_dollar": 2330.73, "additional_payer_notes": "212.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1099.4, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "ALLY-ALIGN (FKA SPARTAN PLAN NJ, INC.)", "plan_name": "ALLY-ALIGN (FKA SPARTAN PLAN NJ, INC.)", "methodology": "fee schedule", "standard_charge_dollar": 1154.37, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Americhoice (UHC)", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1099.4, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Amerihealth", "plan_name": "Amerihealth Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1099.4, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 1615.57, "additional_payer_notes": "146.95% of Medicare Rates" }, { "payer_name": "Clover Health", "plan_name": "Clover Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1099.4, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Coventry", "plan_name": "Coventry Auto", "methodology": "fee schedule", "standard_charge_dollar": 2198.8, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Coventry", "plan_name": "Coventry Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 2198.8, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "fee schedule", "standard_charge_dollar": 1539.16, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Fairprice Healthcare Holdings", "plan_name": "Fairprice Healthcare Holdings", "methodology": "fee schedule", "standard_charge_dollar": 1759.04, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ HMO POS", "methodology": "fee schedule", "standard_charge_dollar": 1949.24, "additional_payer_notes": "177.30% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ Indemnity", "methodology": "fee schedule", "standard_charge_dollar": 1949.24, "additional_payer_notes": "177.30% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ PPO", "methodology": "fee schedule", "standard_charge_dollar": 1949.24, "additional_payer_notes": "177.30% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1099.4, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon NJ Health Medicaid", "methodology": "percent of total billed charges", "standard_charge_percentage": 19.58, "median_amount": 734.65, "10th_percentile": 659.59, "90th_percentile": 734.65, "count": "64" }, { "payer_name": "Humana", "plan_name": "Humana Military Tricare", "methodology": "fee schedule", "standard_charge_dollar": 879.52, "additional_payer_notes": "80.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1099.4, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 1099.4, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC All Payer (02-01-2023 to 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 3752.03 }, { "payer_name": "UHC", "plan_name": "UHC Medicaid (02/01/2023 to 12-31-2026)", "methodology": "percent of total billed charges", "standard_charge_percentage": 19.47, "median_amount": 713.75, "10th_percentile": 640.83, "90th_percentile": 713.75, "count": "13" }, { "payer_name": "UHC", "plan_name": "UHC Oxford (02-01-2023 to 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 3676.0 }, { "payer_name": "UHC - Adhoc", "plan_name": "UHC - Adhoc All Payer", "methodology": "case rate", "standard_charge_dollar": 3752.03 }, { "payer_name": "UHC - Adhoc", "plan_name": "UHC - Adhoc Oxford", "methodology": "case rate", "standard_charge_dollar": 3752.03 }, { "payer_name": "Wellcare", "plan_name": "Wellcare Insurance Exchange", "methodology": "fee schedule", "standard_charge_dollar": 1484.19, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1099.4, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup Medicaid", "methodology": "percent of total billed charges", "standard_charge_percentage": 19.09, "median_amount": 699.75, "10th_percentile": 628.26, "90th_percentile": 699.75, "count": "14" }, { "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1099.4, "additional_payer_notes": "100.00% of Medicare Rates" } ] } ] }, { "description": "Hc Speech/Hearing Therapy Individual, 75 Min", "code_information": [ { "code": "92507", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 413.0, "discounted_cash": 84.0, "minimum": 61.088, "maximum": 678.3, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 178.29, "additional_payer_notes": "212.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medical Rental Network", "methodology": "fee schedule", "standard_charge_dollar": 178.29, "additional_payer_notes": "212.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 84.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "ALLY-ALIGN (FKA SPARTAN PLAN NJ, INC.)", "plan_name": "ALLY-ALIGN (FKA SPARTAN PLAN NJ, INC.)", "methodology": "fee schedule", "standard_charge_dollar": 88.31, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Americhoice (UHC)", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 84.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Amerihealth", "plan_name": "Amerihealth Medicare", "methodology": "fee schedule", "standard_charge_dollar": 84.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 158.0, "additional_payer_notes": "A Indicator - 155.00% of Medicare Rates" }, { "payer_name": "Clover Health", "plan_name": "Clover Medicare", "methodology": "fee schedule", "standard_charge_dollar": 84.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Coventry", "plan_name": "Coventry Auto", "methodology": "fee schedule", "standard_charge_dollar": 168.2, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Coventry", "plan_name": "Coventry Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 168.2, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "fee schedule", "standard_charge_dollar": 117.74, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Fairprice Healthcare Holdings", "plan_name": "Fairprice Healthcare Holdings", "methodology": "fee schedule", "standard_charge_dollar": 134.56 }, { "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ HMO POS", "methodology": "fee schedule", "standard_charge_dollar": 291.58, "additional_payer_notes": "177.30% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ Indemnity", "methodology": "fee schedule", "standard_charge_dollar": 291.58, "additional_payer_notes": "177.30% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ PPO", "methodology": "fee schedule", "standard_charge_dollar": 291.58, "additional_payer_notes": "177.30% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon Medicare", "methodology": "fee schedule", "standard_charge_dollar": 84.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Military Tricare", "methodology": "fee schedule", "standard_charge_dollar": 67.28, "additional_payer_notes": "80.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 84.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 84.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC All Payer (02-01-2023 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 407.0 }, { "payer_name": "UHC", "plan_name": "UHC Oxford (02-01-2023 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 357.0 }, { "payer_name": "UHC - Adhoc", "plan_name": "UHC - Adhoc All Payer", "methodology": "fee schedule", "standard_charge_dollar": 413.0 }, { "payer_name": "UHC - Adhoc", "plan_name": "UHC - Adhoc Oxford", "methodology": "fee schedule", "standard_charge_dollar": 368.0 }, { "payer_name": "Wellcare", "plan_name": "Wellcare Insurance Exchange", "methodology": "fee schedule", "standard_charge_dollar": 113.54, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 84.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup Medicare", "methodology": "fee schedule", "standard_charge_dollar": 84.1, "additional_payer_notes": "100.00% of Medicare Rates" } ] } ] }, { "description": "Hc Eval,Swallow Function,Cine/Video Record, 60 Min", "code_information": [ { "code": "92611", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 755.53, "discounted_cash": 101.0, "minimum": 81.408, "maximum": 680.0, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 215.73, "additional_payer_notes": "212.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medical Rental Network", "methodology": "fee schedule", "standard_charge_dollar": 215.73, "additional_payer_notes": "212.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 101.76, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "ALLY-ALIGN (FKA SPARTAN PLAN NJ, INC.)", "plan_name": "ALLY-ALIGN (FKA SPARTAN PLAN NJ, INC.)", "methodology": "fee schedule", "standard_charge_dollar": 106.85, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Americhoice (UHC)", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 101.76, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Amerihealth", "plan_name": "Amerihealth Medicare", "methodology": "fee schedule", "standard_charge_dollar": 101.76, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 157.73, "additional_payer_notes": "A Indicator - 155.00% of Medicare Rates" }, { "payer_name": "Clover Health", "plan_name": "Clover Medicare", "methodology": "fee schedule", "standard_charge_dollar": 101.76, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Coventry", "plan_name": "Coventry Auto", "methodology": "fee schedule", "standard_charge_dollar": 203.52, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Coventry", "plan_name": "Coventry Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 203.52, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "fee schedule", "standard_charge_dollar": 142.46, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Fairprice Healthcare Holdings", "plan_name": "Fairprice Healthcare Holdings", "methodology": "fee schedule", "standard_charge_dollar": 162.82 }, { "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ HMO POS", "methodology": "fee schedule", "standard_charge_dollar": 533.4, "additional_payer_notes": "177.30% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ Indemnity", "methodology": "fee schedule", "standard_charge_dollar": 533.4, "additional_payer_notes": "177.30% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ PPO", "methodology": "fee schedule", "standard_charge_dollar": 533.4, "additional_payer_notes": "177.30% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon Medicare", "methodology": "fee schedule", "standard_charge_dollar": 101.76, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Military Tricare", "methodology": "fee schedule", "standard_charge_dollar": 81.41, "additional_payer_notes": "80.00% of Medicare Rates" }, { "payer_name": "Keenan", "plan_name": "Keenan", "methodology": "percent of total billed charges", "standard_charge_percentage": 30.0, "median_amount": 142.83, "10th_percentile": 142.83, "90th_percentile": 226.66, "count": "1 through 10" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 101.76, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 101.76, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC All Payer (02-01-2023 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 407.0 }, { "payer_name": "UHC", "plan_name": "UHC Oxford (02-01-2023 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 357.0 }, { "payer_name": "UHC - Adhoc", "plan_name": "UHC - Adhoc All Payer", "methodology": "fee schedule", "standard_charge_dollar": 432.0 }, { "payer_name": "UHC - Adhoc", "plan_name": "UHC - Adhoc Oxford", "methodology": "fee schedule", "standard_charge_dollar": 368.0 }, { "payer_name": "Wellcare", "plan_name": "Wellcare Insurance Exchange", "methodology": "fee schedule", "standard_charge_dollar": 137.38, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 101.76, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup Medicare", "methodology": "fee schedule", "standard_charge_dollar": 101.76, "additional_payer_notes": "100.00% of Medicare Rates" } ] } ] }, { "description": "Hc Perq Art Trluml M-Thrombec &/Nfs Intracranial", "code_information": [ { "code": "61645", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 16160.9, "minimum": 854.09, "maximum": 12928.72, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 854.09, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC All Payer (02-01-2023 to 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 4889.0 }, { "payer_name": "UHC", "plan_name": "UHC Oxford (02-01-2023 to 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 4020.0 }, { "payer_name": "UHC - Adhoc", "plan_name": "UHC - Adhoc All Payer", "methodology": "case rate", "standard_charge_dollar": 5190.0 }, { "payer_name": "UHC - Adhoc", "plan_name": "UHC - Adhoc Oxford", "methodology": "case rate", "standard_charge_dollar": 4143.0 }, { "payer_name": "Wellchoice", "plan_name": "WELLCHOICE HMO of NJ (Empire) Commercial (HMO / HMO POS, PPO)", "methodology": "case rate", "standard_charge_dollar": 1715.0 }, { "payer_name": "Wellchoice", "plan_name": "WELLCHOICE HMO of NJ (Empire) Commercial (Indemnity)", "methodology": "case rate", "standard_charge_dollar": 1978.0 } ] } ] }, { "description": "OTHER SKIN, SUBCUTANEOUS TISSUE AND BREAST PROCEDURES WITH CC", "code_information": [ { "code": "580", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 21526.0, "minimum": 9927.24, "maximum": 38962.603, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "case rate", "standard_charge_dollar": 38962.6, "additional_payer_notes": "181.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medical Rental Network", "methodology": "case rate", "standard_charge_dollar": 38962.6, "additional_payer_notes": "181.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "case rate", "standard_charge_dollar": 17591.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "ALLY-ALIGN (FKA SPARTAN PLAN NJ, INC.)", "plan_name": "ALLY-ALIGN (FKA SPARTAN PLAN NJ, INC.)", "methodology": "case rate", "standard_charge_dollar": 22602.62, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Americhoice (UHC)", "plan_name": "UHC Medicare", "methodology": "case rate", "standard_charge_dollar": 17591.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Amerihealth", "plan_name": "Amerihealth Medicare", "methodology": "case rate", "standard_charge_dollar": 17591.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Commercial", "methodology": "case rate", "standard_charge_dollar": 25280.64 }, { "payer_name": "Clover Health", "plan_name": "Clover Medicare", "methodology": "case rate", "standard_charge_dollar": 17591.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Coventry", "plan_name": "Coventry Auto", "methodology": "case rate", "standard_charge_dollar": 36594.71, "additional_payer_notes": "170.00% of Medicare Rates" }, { "payer_name": "Coventry", "plan_name": "Coventry Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 36594.71, "additional_payer_notes": "170.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "case rate", "standard_charge_dollar": 27984.19, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Fairprice Healthcare Holdings", "plan_name": "Fairprice Healthcare Holdings", "methodology": "case rate", "standard_charge_dollar": 34442.08, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon Medicare", "methodology": "case rate", "standard_charge_dollar": 17591.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon NJ Health Medicaid", "methodology": "case rate", "standard_charge_dollar": 9927.24 }, { "payer_name": "Humana", "plan_name": "Humana Military Tricare", "methodology": "case rate", "standard_charge_dollar": 17221.04, "additional_payer_notes": "80.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 21526.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 29074.2 }, { "payer_name": "UBH", "plan_name": "UBH Medicare", "methodology": "case rate", "standard_charge_dollar": 17591.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC All Payer (02-01-2023 to 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 29127.17 }, { "payer_name": "UHC", "plan_name": "UHC Oxford (02-01-2023 to 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 25384.32 }, { "payer_name": "UHC - Adhoc", "plan_name": "UHC - Adhoc All Payer", "methodology": "case rate", "standard_charge_dollar": 30919.1 }, { "payer_name": "UHC - Adhoc", "plan_name": "UHC - Adhoc Oxford", "methodology": "case rate", "standard_charge_dollar": 26158.46 }, { "payer_name": "Wellcare", "plan_name": "Wellcare Insurance Exchange", "methodology": "case rate", "standard_charge_dollar": 29060.51, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "case rate", "standard_charge_dollar": 17591.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup Medicare", "methodology": "case rate", "standard_charge_dollar": 17591.8, "additional_payer_notes": "100.00% of Medicare Rates" } ] } ] }, { "description": "SIGNS, SYMPTOMS & OTHER FACTORS INFLUENCING HEALTH STATUS - SOI : 1", "code_information": [ { "code": "8611", "type": "APR-DRG" } ], "standard_charges": [ { "setting": "inpatient", "minimum": 4729.43, "maximum": 5202.37, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Better Health - Medi Medi", "methodology": "case rate", "standard_charge_dollar": 5202.37, "additional_payer_notes": "110% of State Medicaid Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Better Health Medicaid", "methodology": "case rate", "standard_charge_dollar": 5202.37, "additional_payer_notes": "110% of State Medicaid Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "case rate", "standard_charge_dollar": 4729.43, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "UBH", "plan_name": "UBH Medicaid", "methodology": "case rate", "standard_charge_dollar": 4729.43, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicaid (02/01/2023 to 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 4824.01, "additional_payer_notes": "102% of State Medicaid Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicaid", "methodology": "case rate", "standard_charge_dollar": 4729.43, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup Medicaid", "methodology": "case rate", "standard_charge_dollar": 4729.43, "additional_payer_notes": "100% of State Medicaid Rates" } ] } ] }, { "description": "SIGNS AND SYMPTOMS WITH MCC", "code_information": [ { "code": "947", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 16226.0, "minimum": 7528.17, "maximum": 29369.965, "payers_information": [ { "payer_name": "Humana", "plan_name": "Humana Military Tricare", "methodology": "case rate", "standard_charge_dollar": 12981.2, "additional_payer_notes": "80.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 16226.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 16490.1 }, { "payer_name": "UBH", "plan_name": "UBH Medicare", "methodology": "case rate", "standard_charge_dollar": 13336.2, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC All Payer (02-01-2023 to 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 21397.01 }, { "payer_name": "UHC", "plan_name": "UHC Oxford (02-01-2023 to 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 18647.49 }, { "payer_name": "UHC - Adhoc", "plan_name": "UHC - Adhoc All Payer", "methodology": "case rate", "standard_charge_dollar": 22713.37 }, { "payer_name": "UHC - Adhoc", "plan_name": "UHC - Adhoc Oxford", "methodology": "case rate", "standard_charge_dollar": 19216.18 }, { "payer_name": "Wellcare", "plan_name": "Wellcare Insurance Exchange", "methodology": "case rate", "standard_charge_dollar": 21905.78, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "case rate", "standard_charge_dollar": 13336.2, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup Medicare", "methodology": "case rate", "standard_charge_dollar": 13336.2, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "case rate", "standard_charge_dollar": 29369.97, "additional_payer_notes": "181.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medical Rental Network", "methodology": "case rate", "standard_charge_dollar": 29369.97, "additional_payer_notes": "181.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "case rate", "standard_charge_dollar": 13336.2, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "ALLY-ALIGN (FKA SPARTAN PLAN NJ, INC.)", "plan_name": "ALLY-ALIGN (FKA SPARTAN PLAN NJ, INC.)", "methodology": "case rate", "standard_charge_dollar": 17037.83, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Americhoice (UHC)", "plan_name": "UHC Medicare", "methodology": "case rate", "standard_charge_dollar": 13336.2, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Amerihealth", "plan_name": "Amerihealth Medicare", "methodology": "case rate", "standard_charge_dollar": 13336.2, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Commercial", "methodology": "case rate", "standard_charge_dollar": 18571.32 }, { "payer_name": "Clover Health", "plan_name": "Clover Medicare", "methodology": "case rate", "standard_charge_dollar": 13336.2, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Coventry", "plan_name": "Coventry Auto", "methodology": "case rate", "standard_charge_dollar": 27585.05, "additional_payer_notes": "170.00% of Medicare Rates" }, { "payer_name": "Coventry", "plan_name": "Coventry Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 27585.05, "additional_payer_notes": "170.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "case rate", "standard_charge_dollar": 21094.45, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Fairprice Healthcare Holdings", "plan_name": "Fairprice Healthcare Holdings", "methodology": "case rate", "standard_charge_dollar": 25962.4, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon Medicare", "methodology": "case rate", "standard_charge_dollar": 13336.2, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon NJ Health Medicaid", "methodology": "case rate", "standard_charge_dollar": 7528.17 } ] } ] }, { "description": "OTHER VASCULAR PROCEDURES WITH CC", "code_information": [ { "code": "253", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 31552.0, "minimum": 16199.68, "maximum": 57110.3689, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "case rate", "standard_charge_dollar": 57110.37, "additional_payer_notes": "181.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medical Rental Network", "methodology": "case rate", "standard_charge_dollar": 57110.37, "additional_payer_notes": "181.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "case rate", "standard_charge_dollar": 25642.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "ALLY-ALIGN (FKA SPARTAN PLAN NJ, INC.)", "plan_name": "ALLY-ALIGN (FKA SPARTAN PLAN NJ, INC.)", "methodology": "case rate", "standard_charge_dollar": 33130.32, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Americhoice (UHC)", "plan_name": "UHC Medicare", "methodology": "case rate", "standard_charge_dollar": 25642.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Amerihealth", "plan_name": "Amerihealth Medicare", "methodology": "case rate", "standard_charge_dollar": 25642.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Commercial", "methodology": "case rate", "standard_charge_dollar": 37973.63 }, { "payer_name": "Clover Health", "plan_name": "Clover Medicare", "methodology": "case rate", "standard_charge_dollar": 25642.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Coventry", "plan_name": "Coventry Auto", "methodology": "case rate", "standard_charge_dollar": 53639.57, "additional_payer_notes": "170.00% of Medicare Rates" }, { "payer_name": "Coventry", "plan_name": "Coventry Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 53639.57, "additional_payer_notes": "170.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "case rate", "standard_charge_dollar": 41018.5, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Fairprice Healthcare Holdings", "plan_name": "Fairprice Healthcare Holdings", "methodology": "case rate", "standard_charge_dollar": 50484.3, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon Medicare", "methodology": "case rate", "standard_charge_dollar": 25642.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon NJ Health Medicaid", "methodology": "case rate", "standard_charge_dollar": 16199.68 }, { "payer_name": "Humana", "plan_name": "Humana Military Tricare", "methodology": "case rate", "standard_charge_dollar": 25242.15, "additional_payer_notes": "80.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 31552.69, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 38773.4 }, { "payer_name": "UBH", "plan_name": "UBH Medicare", "methodology": "case rate", "standard_charge_dollar": 25642.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC All Payer (02-01-2023 to 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 43751.43 }, { "payer_name": "UHC", "plan_name": "UHC Oxford (02-01-2023 to 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 38129.36 }, { "payer_name": "UHC - Adhoc", "plan_name": "UHC - Adhoc All Payer", "methodology": "case rate", "standard_charge_dollar": 46443.07 }, { "payer_name": "UHC - Adhoc", "plan_name": "UHC - Adhoc Oxford", "methodology": "case rate", "standard_charge_dollar": 39292.19 }, { "payer_name": "Wellcare", "plan_name": "Wellcare Insurance Exchange", "methodology": "case rate", "standard_charge_dollar": 42596.13, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "case rate", "standard_charge_dollar": 25642.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup Medicare", "methodology": "case rate", "standard_charge_dollar": 25642.7, "additional_payer_notes": "100.00% of Medicare Rates" } ] } ] }, { "description": "NEONATE BWT 2000-2499G, NORMAL NEWBORN OR NEONATE W OTHER PROBLEM - SOI : 4", "code_information": [ { "code": "6264", "type": "APR-DRG" } ], "standard_charges": [ { "setting": "inpatient", "minimum": 28487.55, "maximum": 31336.3, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Better Health - Medi Medi", "methodology": "case rate", "standard_charge_dollar": 31336.3, "additional_payer_notes": "110% of State Medicaid Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Better Health Medicaid", "methodology": "case rate", "standard_charge_dollar": 31336.3, "additional_payer_notes": "110% of State Medicaid Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "case rate", "standard_charge_dollar": 28487.55, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "UBH", "plan_name": "UBH Medicaid", "methodology": "case rate", "standard_charge_dollar": 28487.55, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicaid (02/01/2023 to 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 29057.3, "additional_payer_notes": "102% of State Medicaid Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicaid", "methodology": "case rate", "standard_charge_dollar": 28487.55, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup Medicaid", "methodology": "case rate", "standard_charge_dollar": 28487.55, "additional_payer_notes": "100% of State Medicaid Rates" } ] } ] }, { "description": "Knee arthroscopysurgery - 29882 - ", "code_information": [ { "code": "29882", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 9927.99, "discounted_cash": 3868.0, "minimum": 1715.0, "maximum": 8200.5204, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 8200.52, "additional_payer_notes": "212.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medical Rental Network", "methodology": "fee schedule", "standard_charge_dollar": 8200.52, "additional_payer_notes": "212.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3868.17, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "ALLY-ALIGN (FKA SPARTAN PLAN NJ, INC.)", "plan_name": "ALLY-ALIGN (FKA SPARTAN PLAN NJ, INC.)", "methodology": "fee schedule", "standard_charge_dollar": 4061.58, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Americhoice (UHC)", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3868.17, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Amerihealth", "plan_name": "Amerihealth Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3868.17, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 5684.28, "additional_payer_notes": "146.95% of Medicare Rates" }, { "payer_name": "Clover Health", "plan_name": "Clover Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3868.17, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Coventry", "plan_name": "Coventry Auto", "methodology": "fee schedule", "standard_charge_dollar": 7736.34, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Coventry", "plan_name": "Coventry Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 7736.34, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "fee schedule", "standard_charge_dollar": 5415.44, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Fairprice Healthcare Holdings", "plan_name": "Fairprice Healthcare Holdings", "methodology": "fee schedule", "standard_charge_dollar": 6189.07, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ HMO POS", "methodology": "fee schedule", "standard_charge_dollar": 6858.27, "additional_payer_notes": "177.30% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ Indemnity", "methodology": "fee schedule", "standard_charge_dollar": 6858.27, "additional_payer_notes": "177.30% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ PPO", "methodology": "fee schedule", "standard_charge_dollar": 6858.27, "additional_payer_notes": "177.30% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3868.17, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Military Tricare", "methodology": "fee schedule", "standard_charge_dollar": 3094.54, "additional_payer_notes": "80.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3868.17, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 3868.17, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC All Payer (02-01-2023 to 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 5378.0 }, { "payer_name": "UHC", "plan_name": "UHC Oxford (02-01-2023 to 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 5169.0 }, { "payer_name": "UHC - Adhoc", "plan_name": "UHC - Adhoc All Payer", "methodology": "case rate", "standard_charge_dollar": 5709.0 }, { "payer_name": "UHC - Adhoc", "plan_name": "UHC - Adhoc Oxford", "methodology": "case rate", "standard_charge_dollar": 5327.0 }, { "payer_name": "Wellcare", "plan_name": "Wellcare Insurance Exchange", "methodology": "fee schedule", "standard_charge_dollar": 5222.03, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3868.17, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellchoice", "plan_name": "WELLCHOICE HMO of NJ (Empire) Commercial (HMO / HMO POS, PPO)", "methodology": "case rate", "standard_charge_dollar": 1715.0 }, { "payer_name": "Wellchoice", "plan_name": "WELLCHOICE HMO of NJ (Empire) Commercial (Indemnity)", "methodology": "case rate", "standard_charge_dollar": 1978.0 }, { "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3868.17, "additional_payer_notes": "100.00% of Medicare Rates" } ] } ] }, { "description": "Hc Sensory Integration Ea 15 Min", "code_information": [ { "code": "97533", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 182.0, "discounted_cash": 68.0, "minimum": 34.7438, "maximum": 182.0, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 146.13, "additional_payer_notes": "212.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medical Rental Network", "methodology": "fee schedule", "standard_charge_dollar": 146.13, "additional_payer_notes": "212.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 68.93, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "ALLY-ALIGN (FKA SPARTAN PLAN NJ, INC.)", "plan_name": "ALLY-ALIGN (FKA SPARTAN PLAN NJ, INC.)", "methodology": "fee schedule", "standard_charge_dollar": 72.38, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Americhoice (UHC)", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 68.93, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Amerihealth", "plan_name": "Amerihealth Medicare", "methodology": "fee schedule", "standard_charge_dollar": 68.93, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 158.0, "additional_payer_notes": "A Indicator - 155.00% of Medicare Rates" }, { "payer_name": "Clover Health", "plan_name": "Clover Medicare", "methodology": "fee schedule", "standard_charge_dollar": 68.93, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Coventry", "plan_name": "Coventry Auto", "methodology": "fee schedule", "standard_charge_dollar": 137.86, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Coventry", "plan_name": "Coventry Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 137.86, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "fee schedule", "standard_charge_dollar": 96.5, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Fairprice Healthcare Holdings", "plan_name": "Fairprice Healthcare Holdings", "methodology": "fee schedule", "standard_charge_dollar": 110.29 }, { "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ HMO POS", "methodology": "fee schedule", "standard_charge_dollar": 128.49, "additional_payer_notes": "177.30% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ Indemnity", "methodology": "fee schedule", "standard_charge_dollar": 128.49, "additional_payer_notes": "177.30% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ PPO", "methodology": "fee schedule", "standard_charge_dollar": 128.49, "additional_payer_notes": "177.30% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon Medicare", "methodology": "fee schedule", "standard_charge_dollar": 68.93, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Military Tricare", "methodology": "fee schedule", "standard_charge_dollar": 55.14, "additional_payer_notes": "80.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 68.93, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 68.93, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC All Payer (02-01-2023 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 182.0 }, { "payer_name": "UHC", "plan_name": "UHC Oxford (02-01-2023 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 182.0 }, { "payer_name": "UHC - Adhoc", "plan_name": "UHC - Adhoc All Payer", "methodology": "fee schedule", "standard_charge_dollar": 182.0 }, { "payer_name": "UHC - Adhoc", "plan_name": "UHC - Adhoc Oxford", "methodology": "fee schedule", "standard_charge_dollar": 182.0 }, { "payer_name": "Wellcare", "plan_name": "Wellcare Insurance Exchange", "methodology": "fee schedule", "standard_charge_dollar": 93.06, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 68.93, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup Medicare", "methodology": "fee schedule", "standard_charge_dollar": 68.93, "additional_payer_notes": "100.00% of Medicare Rates" } ] } ] }, { "description": "INTERSTITIAL LUNG DISEASE WITH CC", "code_information": [ { "code": "197", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 12524.0, "minimum": 6254.95, "maximum": 22670.1957, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "case rate", "standard_charge_dollar": 22670.2, "additional_payer_notes": "181.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medical Rental Network", "methodology": "case rate", "standard_charge_dollar": 22670.2, "additional_payer_notes": "181.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "case rate", "standard_charge_dollar": 10363.9, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "ALLY-ALIGN (FKA SPARTAN PLAN NJ, INC.)", "plan_name": "ALLY-ALIGN (FKA SPARTAN PLAN NJ, INC.)", "methodology": "case rate", "standard_charge_dollar": 13151.22, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Americhoice (UHC)", "plan_name": "UHC Medicare", "methodology": "case rate", "standard_charge_dollar": 10363.9, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Amerihealth", "plan_name": "Amerihealth Medicare", "methodology": "case rate", "standard_charge_dollar": 10363.9, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Commercial", "methodology": "case rate", "standard_charge_dollar": 13885.33 }, { "payer_name": "Clover Health", "plan_name": "Clover Medicare", "methodology": "case rate", "standard_charge_dollar": 10363.9, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Coventry", "plan_name": "Coventry Auto", "methodology": "case rate", "standard_charge_dollar": 21292.45, "additional_payer_notes": "170.00% of Medicare Rates" }, { "payer_name": "Coventry", "plan_name": "Coventry Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 21292.45, "additional_payer_notes": "170.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "case rate", "standard_charge_dollar": 16282.46, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Fairprice Healthcare Holdings", "plan_name": "Fairprice Healthcare Holdings", "methodology": "case rate", "standard_charge_dollar": 20039.95, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon Medicare", "methodology": "case rate", "standard_charge_dollar": 10363.9, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon NJ Health Medicaid", "methodology": "case rate", "standard_charge_dollar": 6254.95 }, { "payer_name": "Humana", "plan_name": "Humana Military Tricare", "methodology": "case rate", "standard_charge_dollar": 10019.98, "additional_payer_notes": "80.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 12524.97, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 12219.8 }, { "payer_name": "UBH", "plan_name": "UBH Medicare", "methodology": "case rate", "standard_charge_dollar": 10363.9, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC All Payer (02-01-2023 to 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 15998.03 }, { "payer_name": "UHC", "plan_name": "UHC Oxford (02-01-2023 to 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 13942.28 }, { "payer_name": "UHC - Adhoc", "plan_name": "UHC - Adhoc All Payer", "methodology": "case rate", "standard_charge_dollar": 16982.25 }, { "payer_name": "UHC - Adhoc", "plan_name": "UHC - Adhoc Oxford", "methodology": "case rate", "standard_charge_dollar": 14367.48 }, { "payer_name": "Wellcare", "plan_name": "Wellcare Insurance Exchange", "methodology": "case rate", "standard_charge_dollar": 16908.71, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "case rate", "standard_charge_dollar": 10363.9, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup Medicare", "methodology": "case rate", "standard_charge_dollar": 10363.9, "additional_payer_notes": "100.00% of Medicare Rates" } ] } ] }, { "description": "LYMPHOMA, MYELOMA & NON-ACUTE LEUKEMIA - SOI : 1", "code_information": [ { "code": "6911", "type": "APR-DRG" } ], "standard_charges": [ { "setting": "inpatient", "minimum": 10695.1, "maximum": 11764.61, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Better Health - Medi Medi", "methodology": "case rate", "standard_charge_dollar": 11764.61, "additional_payer_notes": "110% of State Medicaid Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Better Health Medicaid", "methodology": "case rate", "standard_charge_dollar": 11764.61, "additional_payer_notes": "110% of State Medicaid Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "case rate", "standard_charge_dollar": 10695.1, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "UBH", "plan_name": "UBH Medicaid", "methodology": "case rate", "standard_charge_dollar": 10695.1, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicaid (02/01/2023 to 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 10909.0, "additional_payer_notes": "102% of State Medicaid Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicaid", "methodology": "case rate", "standard_charge_dollar": 10695.1, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup Medicaid", "methodology": "case rate", "standard_charge_dollar": 10695.1, "additional_payer_notes": "100% of State Medicaid Rates" } ] } ] }, { "description": "PREMATURITY WITHOUT MAJOR PROBLEMS", "code_information": [ { "code": "792", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 29860.0, "minimum": 2970.07, "maximum": 54048.1023, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "case rate", "standard_charge_dollar": 54048.1, "additional_payer_notes": "181.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medical Rental Network", "methodology": "case rate", "standard_charge_dollar": 54048.1, "additional_payer_notes": "181.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "case rate", "standard_charge_dollar": 24284.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "ALLY-ALIGN (FKA SPARTAN PLAN NJ, INC.)", "plan_name": "ALLY-ALIGN (FKA SPARTAN PLAN NJ, INC.)", "methodology": "case rate", "standard_charge_dollar": 31353.87, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Americhoice (UHC)", "plan_name": "UHC Medicare", "methodology": "case rate", "standard_charge_dollar": 24284.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Amerihealth", "plan_name": "Amerihealth Medicare", "methodology": "case rate", "standard_charge_dollar": 24284.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Commercial", "methodology": "case rate", "standard_charge_dollar": 35831.8 }, { "payer_name": "Clover Health", "plan_name": "Clover Medicare", "methodology": "case rate", "standard_charge_dollar": 24284.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Coventry", "plan_name": "Coventry Auto", "methodology": "case rate", "standard_charge_dollar": 50763.41, "additional_payer_notes": "170.00% of Medicare Rates" }, { "payer_name": "Coventry", "plan_name": "Coventry Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 50763.41, "additional_payer_notes": "170.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "case rate", "standard_charge_dollar": 38819.08, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Fairprice Healthcare Holdings", "plan_name": "Fairprice Healthcare Holdings", "methodology": "case rate", "standard_charge_dollar": 47777.33, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon Medicare", "methodology": "case rate", "standard_charge_dollar": 24284.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon NJ Health Medicaid", "methodology": "case rate", "standard_charge_dollar": 14244.56 }, { "payer_name": "Humana", "plan_name": "Humana Military Tricare", "methodology": "case rate", "standard_charge_dollar": 23888.66, "additional_payer_notes": "80.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 29860.83, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 2970.07 }, { "payer_name": "UBH", "plan_name": "UBH Medicare", "methodology": "case rate", "standard_charge_dollar": 24284.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC All Payer (02-01-2023 to 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 41283.72 }, { "payer_name": "UHC", "plan_name": "UHC Oxford (02-01-2023 to 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 35978.75 }, { "payer_name": "UHC - Adhoc", "plan_name": "UHC - Adhoc All Payer", "methodology": "case rate", "standard_charge_dollar": 43823.54 }, { "payer_name": "UHC - Adhoc", "plan_name": "UHC - Adhoc Oxford", "methodology": "case rate", "standard_charge_dollar": 37075.99 }, { "payer_name": "Wellcare", "plan_name": "Wellcare Insurance Exchange", "methodology": "case rate", "standard_charge_dollar": 40312.12, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "case rate", "standard_charge_dollar": 24284.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup Medicare", "methodology": "case rate", "standard_charge_dollar": 24284.1, "additional_payer_notes": "100.00% of Medicare Rates" } ] } ] }, { "description": "MALIGNANT BREAST DISORDERS - SOI : 2", "code_information": [ { "code": "3822", "type": "APR-DRG" } ], "standard_charges": [ { "setting": "inpatient", "minimum": 8860.78, "maximum": 9746.85, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Better Health - Medi Medi", "methodology": "case rate", "standard_charge_dollar": 9746.85, "additional_payer_notes": "110% of State Medicaid Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Better Health Medicaid", "methodology": "case rate", "standard_charge_dollar": 9746.85, "additional_payer_notes": "110% of State Medicaid Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "case rate", "standard_charge_dollar": 8860.78, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "UBH", "plan_name": "UBH Medicaid", "methodology": "case rate", "standard_charge_dollar": 8860.78, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicaid (02/01/2023 to 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 9037.99, "additional_payer_notes": "102% of State Medicaid Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicaid", "methodology": "case rate", "standard_charge_dollar": 8860.78, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup Medicaid", "methodology": "case rate", "standard_charge_dollar": 8860.78, "additional_payer_notes": "100% of State Medicaid Rates" } ] } ] }, { "description": "MAJOR CARDIOTHORACIC REPAIR OF HEART ANOMALY - SOI : 1", "code_information": [ { "code": "1601", "type": "APR-DRG" } ], "standard_charges": [ { "setting": "inpatient", "minimum": 36134.06, "maximum": 39747.47, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Better Health - Medi Medi", "methodology": "case rate", "standard_charge_dollar": 39747.47, "additional_payer_notes": "110% of State Medicaid Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Better Health Medicaid", "methodology": "case rate", "standard_charge_dollar": 39747.47, "additional_payer_notes": "110% of State Medicaid Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "case rate", "standard_charge_dollar": 36134.06, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "UBH", "plan_name": "UBH Medicaid", "methodology": "case rate", "standard_charge_dollar": 36134.06, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicaid (02/01/2023 to 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 36856.74, "additional_payer_notes": "102% of State Medicaid Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicaid", "methodology": "case rate", "standard_charge_dollar": 36134.06, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup Medicaid", "methodology": "case rate", "standard_charge_dollar": 36134.06, "additional_payer_notes": "100% of State Medicaid Rates" } ] } ] }, { "description": "Hc Mri Abdomen Wo Contrast", "code_information": [ { "code": "74181", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 3596.0, "discounted_cash": 282.0, "minimum": 225.656, "maximum": 3056.6, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medical Rental Network", "methodology": "fee schedule", "standard_charge_dollar": 597.99, "additional_payer_notes": "212.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 282.07, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "ALLY-ALIGN (FKA SPARTAN PLAN NJ, INC.)", "plan_name": "ALLY-ALIGN (FKA SPARTAN PLAN NJ, INC.)", "methodology": "fee schedule", "standard_charge_dollar": 296.17, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Americhoice (UHC)", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 282.07, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Amerihealth", "plan_name": "Amerihealth HMO", "methodology": "fee schedule", "standard_charge_dollar": 765.7 }, { "payer_name": "Amerihealth", "plan_name": "Amerihealth Medicare", "methodology": "fee schedule", "standard_charge_dollar": 282.07, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 414.5, "additional_payer_notes": "146.95% of Medicare Rates" }, { "payer_name": "Clover Health", "plan_name": "Clover Medicare", "methodology": "fee schedule", "standard_charge_dollar": 282.07, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Coventry", "plan_name": "Coventry Auto", "methodology": "fee schedule", "standard_charge_dollar": 564.14, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Coventry", "plan_name": "Coventry Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 564.14, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "fee schedule", "standard_charge_dollar": 394.9, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Fairprice Healthcare Holdings", "plan_name": "Fairprice Healthcare Holdings", "methodology": "fee schedule", "standard_charge_dollar": 451.31, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ HMO POS", "methodology": "fee schedule", "standard_charge_dollar": 500.11, "additional_payer_notes": "177.30% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ Indemnity", "methodology": "fee schedule", "standard_charge_dollar": 500.11, "additional_payer_notes": "177.30% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ PPO", "methodology": "fee schedule", "standard_charge_dollar": 500.11, "additional_payer_notes": "177.30% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon Medicare", "methodology": "fee schedule", "standard_charge_dollar": 282.07, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Military Tricare", "methodology": "fee schedule", "standard_charge_dollar": 225.66, "additional_payer_notes": "80.00% of Medicare Rates" }, { "payer_name": "Keenan", "plan_name": "Keenan", "methodology": "percent of total billed charges", "standard_charge_percentage": 30.0, "median_amount": 1078.8, "10th_percentile": 1078.8, "90th_percentile": 1078.8, "count": "1 through 10" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 282.07, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 282.07, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC All Payer (02-01-2023 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 345.2 }, { "payer_name": "UHC", "plan_name": "UHC Oxford (02-01-2023 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 345.2 }, { "payer_name": "UHC - Adhoc", "plan_name": "UHC - Adhoc All Payer", "methodology": "fee schedule", "standard_charge_dollar": 230.13 }, { "payer_name": "UHC - Adhoc", "plan_name": "UHC - Adhoc Oxford", "methodology": "fee schedule", "standard_charge_dollar": 230.13 }, { "payer_name": "Wellcare", "plan_name": "Wellcare Insurance Exchange", "methodology": "fee schedule", "standard_charge_dollar": 380.79, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 282.07, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup Medicare", "methodology": "fee schedule", "standard_charge_dollar": 282.07, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 597.99, "additional_payer_notes": "212.00% of Medicare Rates" } ] } ] }, { "description": "Hc (Sup Shell A6457) Tubular Dressing - A6457 - RU272066", "code_information": [ { "code": "A6457", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "payers_information": [ { "payer_name": "Horizon", "plan_name": "Horizon NJ Health Medicaid", "methodology": "percent of total billed charges", "standard_charge_percentage": 19.58, "median_amount": 9.19, "10th_percentile": 9.19, "90th_percentile": 38.57, "count": "1 through 10" } ] } ] }, { "description": "SPINAL DISORDERS & INJURIES - SOI : 3", "code_information": [ { "code": "0403", "type": "APR-DRG" } ], "standard_charges": [ { "setting": "inpatient", "minimum": 21772.99, "maximum": 23950.29, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Better Health - Medi Medi", "methodology": "case rate", "standard_charge_dollar": 23950.29, "additional_payer_notes": "110% of State Medicaid Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Better Health Medicaid", "methodology": "case rate", "standard_charge_dollar": 23950.29, "additional_payer_notes": "110% of State Medicaid Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "case rate", "standard_charge_dollar": 21772.99, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "UBH", "plan_name": "UBH Medicaid", "methodology": "case rate", "standard_charge_dollar": 21772.99, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicaid (02/01/2023 to 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 22208.45, "additional_payer_notes": "102% of State Medicaid Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicaid", "methodology": "case rate", "standard_charge_dollar": 21772.99, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup Medicaid", "methodology": "case rate", "standard_charge_dollar": 21772.99, "additional_payer_notes": "100% of State Medicaid Rates" } ] } ] }, { "description": "OTHER PROCEDURES OF BLOOD & BLOOD-FORMING ORGANS - SOI : 2", "code_information": [ { "code": "6512", "type": "APR-DRG" } ], "standard_charges": [ { "setting": "inpatient", "minimum": 19231.01, "maximum": 21154.11, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Better Health - Medi Medi", "methodology": "case rate", "standard_charge_dollar": 21154.11, "additional_payer_notes": "110% of State Medicaid Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Better Health Medicaid", "methodology": "case rate", "standard_charge_dollar": 21154.11, "additional_payer_notes": "110% of State Medicaid Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "case rate", "standard_charge_dollar": 19231.01, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "UBH", "plan_name": "UBH Medicaid", "methodology": "case rate", "standard_charge_dollar": 19231.01, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicaid (02/01/2023 to 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 19615.63, "additional_payer_notes": "102% of State Medicaid Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicaid", "methodology": "case rate", "standard_charge_dollar": 19231.01, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup Medicaid", "methodology": "case rate", "standard_charge_dollar": 19231.01, "additional_payer_notes": "100% of State Medicaid Rates" } ] } ] }, { "description": "Unlisted Px Nervous System", "code_information": [ { "code": "64999", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 14909.6, "discounted_cash": 362.0, "minimum": 259.519, "maximum": 11927.68, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 769.28, "additional_payer_notes": "212.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medical Rental Network", "methodology": "fee schedule", "standard_charge_dollar": 769.28, "additional_payer_notes": "212.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 362.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "ALLY-ALIGN (FKA SPARTAN PLAN NJ, INC.)", "plan_name": "ALLY-ALIGN (FKA SPARTAN PLAN NJ, INC.)", "methodology": "fee schedule", "standard_charge_dollar": 381.01, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Americhoice (UHC)", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 362.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Amerihealth", "plan_name": "Amerihealth Medicare", "methodology": "fee schedule", "standard_charge_dollar": 362.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 533.24, "additional_payer_notes": "146.95% of Medicare Rates" }, { "payer_name": "Clover Health", "plan_name": "Clover Medicare", "methodology": "fee schedule", "standard_charge_dollar": 362.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Coventry", "plan_name": "Coventry Auto", "methodology": "fee schedule", "standard_charge_dollar": 725.74, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Coventry", "plan_name": "Coventry Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 725.74, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "fee schedule", "standard_charge_dollar": 508.02, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Fairprice Healthcare Holdings", "plan_name": "Fairprice Healthcare Holdings", "methodology": "fee schedule", "standard_charge_dollar": 580.59, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ HMO POS", "methodology": "fee schedule", "standard_charge_dollar": 643.37, "additional_payer_notes": "177.30% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ Indemnity", "methodology": "fee schedule", "standard_charge_dollar": 643.37, "additional_payer_notes": "177.30% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ PPO", "methodology": "fee schedule", "standard_charge_dollar": 643.37, "additional_payer_notes": "177.30% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon Medicare", "methodology": "fee schedule", "standard_charge_dollar": 362.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Military Tricare", "methodology": "fee schedule", "standard_charge_dollar": 290.3, "additional_payer_notes": "80.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 362.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 362.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC All Payer (02-01-2023 to 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 3057.0 }, { "payer_name": "UHC", "plan_name": "UHC Oxford (02-01-2023 to 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 2297.0 }, { "payer_name": "UHC - Adhoc", "plan_name": "UHC - Adhoc All Payer", "methodology": "case rate", "standard_charge_dollar": 3245.0 }, { "payer_name": "UHC - Adhoc", "plan_name": "UHC - Adhoc Oxford", "methodology": "case rate", "standard_charge_dollar": 2367.0 }, { "payer_name": "Wellcare", "plan_name": "Wellcare Insurance Exchange", "methodology": "fee schedule", "standard_charge_dollar": 489.87, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 362.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellchoice", "plan_name": "WELLCHOICE HMO of NJ (Empire) Commercial (HMO / HMO POS, PPO)", "methodology": "case rate", "standard_charge_dollar": 1715.0 }, { "payer_name": "Wellchoice", "plan_name": "WELLCHOICE HMO of NJ (Empire) Commercial (Indemnity)", "methodology": "case rate", "standard_charge_dollar": 1978.0 }, { "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup Medicare", "methodology": "fee schedule", "standard_charge_dollar": 362.87, "additional_payer_notes": "100.00% of Medicare Rates" } ] } ] }, { "description": "Hc Assay Of Procainamide", "code_information": [ { "code": "80190", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 87.0, "discounted_cash": 60.0, "minimum": 16.6083, "maximum": 87.0, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 87.0, "additional_payer_notes": "212.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medical Rental Network", "methodology": "fee schedule", "standard_charge_dollar": 87.0, "additional_payer_notes": "212.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 60.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "ALLY-ALIGN (FKA SPARTAN PLAN NJ, INC.)", "plan_name": "ALLY-ALIGN (FKA SPARTAN PLAN NJ, INC.)", "methodology": "fee schedule", "standard_charge_dollar": 63.0, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Americhoice (UHC)", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 60.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Amerihealth", "plan_name": "Amerihealth Medicare", "methodology": "fee schedule", "standard_charge_dollar": 60.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 87.0, "additional_payer_notes": "Laboratory - 145.00% of Medicare Rates" }, { "payer_name": "Clover Health", "plan_name": "Clover Medicare", "methodology": "fee schedule", "standard_charge_dollar": 60.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Coventry", "plan_name": "Coventry Auto", "methodology": "fee schedule", "standard_charge_dollar": 87.0, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Coventry", "plan_name": "Coventry Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 87.0, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "fee schedule", "standard_charge_dollar": 84.0, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Fairprice Healthcare Holdings", "plan_name": "Fairprice Healthcare Holdings", "methodology": "fee schedule", "standard_charge_dollar": 72.0, "additional_payer_notes": "Laboratory - 120.00% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ HMO POS", "methodology": "fee schedule", "standard_charge_dollar": 61.42, "additional_payer_notes": "177.30% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ Indemnity", "methodology": "fee schedule", "standard_charge_dollar": 61.42, "additional_payer_notes": "177.30% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ PPO", "methodology": "fee schedule", "standard_charge_dollar": 61.42, "additional_payer_notes": "177.30% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon Medicare", "methodology": "fee schedule", "standard_charge_dollar": 60.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Military Tricare", "methodology": "fee schedule", "standard_charge_dollar": 48.0, "additional_payer_notes": "80.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 60.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 60.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC All Payer (02-01-2023 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 36.0 }, { "payer_name": "UHC", "plan_name": "UHC Medicaid (02/01/2023 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 48.0 }, { "payer_name": "UHC", "plan_name": "UHC Oxford (02-01-2023 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 36.0 }, { "payer_name": "UHC - Adhoc", "plan_name": "UHC - Adhoc All Payer", "methodology": "fee schedule", "standard_charge_dollar": 60.0 }, { "payer_name": "UHC - Adhoc", "plan_name": "UHC - Adhoc Oxford", "methodology": "fee schedule", "standard_charge_dollar": 60.0 }, { "payer_name": "Wellcare", "plan_name": "Wellcare Insurance Exchange", "methodology": "fee schedule", "standard_charge_dollar": 81.0, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 60.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup Medicare", "methodology": "fee schedule", "standard_charge_dollar": 60.0, "additional_payer_notes": "100.00% of Medicare Rates" } ] } ] }, { "description": "SPINAL FUSION EXCEPT CERVICAL WITH MCC", "code_information": [ { "code": "459", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "minimum": 39868.83, "maximum": 123948.1224, "payers_information": [ { "payer_name": "Horizon", "plan_name": "Horizon NJ Health Medicaid", "methodology": "case rate", "standard_charge_dollar": 39868.83 } ] } ] }, { "description": "HYPOVOLEMIA & RELATED ELECTROLYTE DISORDERS - SOI : 1", "code_information": [ { "code": "4221", "type": "APR-DRG" } ], "standard_charges": [ { "setting": "inpatient", "minimum": 4404.63, "maximum": 4845.1, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Better Health - Medi Medi", "methodology": "case rate", "standard_charge_dollar": 4845.1, "additional_payer_notes": "110% of State Medicaid Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Better Health Medicaid", "methodology": "case rate", "standard_charge_dollar": 4845.1, "additional_payer_notes": "110% of State Medicaid Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "case rate", "standard_charge_dollar": 4404.63, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "UBH", "plan_name": "UBH Medicaid", "methodology": "case rate", "standard_charge_dollar": 4404.63, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicaid (02/01/2023 to 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 4492.72, "additional_payer_notes": "102% of State Medicaid Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicaid", "methodology": "case rate", "standard_charge_dollar": 4404.63, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup Medicaid", "methodology": "case rate", "standard_charge_dollar": 4404.63, "additional_payer_notes": "100% of State Medicaid Rates" } ] } ] }, { "description": "Hc Endomysial Antibody Each Immunoglobulin Class", "code_information": [ { "code": "86231", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 42.92, "discounted_cash": 12.0, "minimum": 7.25, "maximum": 36.482, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 25.63, "additional_payer_notes": "212.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medical Rental Network", "methodology": "fee schedule", "standard_charge_dollar": 25.63, "additional_payer_notes": "212.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 12.09, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "ALLY-ALIGN (FKA SPARTAN PLAN NJ, INC.)", "plan_name": "ALLY-ALIGN (FKA SPARTAN PLAN NJ, INC.)", "methodology": "fee schedule", "standard_charge_dollar": 12.69, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Americhoice (UHC)", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 12.09, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Amerihealth", "plan_name": "Amerihealth Medicare", "methodology": "fee schedule", "standard_charge_dollar": 12.09, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 17.53, "additional_payer_notes": "Laboratory - 145.00% of Medicare Rates" }, { "payer_name": "Clover Health", "plan_name": "Clover Medicare", "methodology": "fee schedule", "standard_charge_dollar": 12.09, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Coventry", "plan_name": "Coventry Auto", "methodology": "fee schedule", "standard_charge_dollar": 24.18, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Coventry", "plan_name": "Coventry Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 24.18, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "fee schedule", "standard_charge_dollar": 16.93, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Fairprice Healthcare Holdings", "plan_name": "Fairprice Healthcare Holdings", "methodology": "fee schedule", "standard_charge_dollar": 14.51, "additional_payer_notes": "Laboratory - 120.00% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ HMO POS", "methodology": "fee schedule", "standard_charge_dollar": 30.3, "additional_payer_notes": "177.30% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ Indemnity", "methodology": "fee schedule", "standard_charge_dollar": 30.3, "additional_payer_notes": "177.30% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ PPO", "methodology": "fee schedule", "standard_charge_dollar": 30.3, "additional_payer_notes": "177.30% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon Medicare", "methodology": "fee schedule", "standard_charge_dollar": 12.09, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Military Tricare", "methodology": "fee schedule", "standard_charge_dollar": 9.67, "additional_payer_notes": "80.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 12.09, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 12.09, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC All Payer (02-01-2023 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 7.25 }, { "payer_name": "UHC", "plan_name": "UHC Medicaid (02/01/2023 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 9.67 }, { "payer_name": "UHC", "plan_name": "UHC Oxford (02-01-2023 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 7.25 }, { "payer_name": "UHC - Adhoc", "plan_name": "UHC - Adhoc All Payer", "methodology": "fee schedule", "standard_charge_dollar": 12.09 }, { "payer_name": "UHC - Adhoc", "plan_name": "UHC - Adhoc Oxford", "methodology": "fee schedule", "standard_charge_dollar": 12.09 }, { "payer_name": "Wellcare", "plan_name": "Wellcare Insurance Exchange", "methodology": "fee schedule", "standard_charge_dollar": 16.32, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 12.09, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup Medicare", "methodology": "fee schedule", "standard_charge_dollar": 12.09, "additional_payer_notes": "100.00% of Medicare Rates" } ] } ] }, { "description": "ADRENAL PROCEDURES - SOI : 3", "code_information": [ { "code": "4013", "type": "APR-DRG" } ], "standard_charges": [ { "setting": "inpatient", "minimum": 37335.43, "maximum": 41068.97, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Better Health - Medi Medi", "methodology": "case rate", "standard_charge_dollar": 41068.97, "additional_payer_notes": "110% of State Medicaid Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Better Health Medicaid", "methodology": "case rate", "standard_charge_dollar": 41068.97, "additional_payer_notes": "110% of State Medicaid Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "case rate", "standard_charge_dollar": 37335.43, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "UBH", "plan_name": "UBH Medicaid", "methodology": "case rate", "standard_charge_dollar": 37335.43, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicaid (02/01/2023 to 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 38082.14, "additional_payer_notes": "102% of State Medicaid Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicaid", "methodology": "case rate", "standard_charge_dollar": 37335.43, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup Medicaid", "methodology": "case rate", "standard_charge_dollar": 37335.43, "additional_payer_notes": "100% of State Medicaid Rates" } ] } ] }, { "description": "OTHER CARDIOTHORACIC & THORACIC VASCULAR PROCEDURES - SOI : 1", "code_information": [ { "code": "1671", "type": "APR-DRG" } ], "standard_charges": [ { "setting": "inpatient", "minimum": 36562.02, "maximum": 40218.23, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Better Health - Medi Medi", "methodology": "case rate", "standard_charge_dollar": 40218.23, "additional_payer_notes": "110% of State Medicaid Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Better Health Medicaid", "methodology": "case rate", "standard_charge_dollar": 40218.23, "additional_payer_notes": "110% of State Medicaid Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "case rate", "standard_charge_dollar": 36562.02, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "UBH", "plan_name": "UBH Medicaid", "methodology": "case rate", "standard_charge_dollar": 36562.02, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicaid (02/01/2023 to 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 37293.26, "additional_payer_notes": "102% of State Medicaid Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicaid", "methodology": "case rate", "standard_charge_dollar": 36562.02, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup Medicaid", "methodology": "case rate", "standard_charge_dollar": 36562.02, "additional_payer_notes": "100% of State Medicaid Rates" } ] } ] }, { "description": "Hc Remv Transven Pacer Electrode,2 Lead", "code_information": [ { "code": "33235", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 16121.5, "discounted_cash": 4417.0, "minimum": 2472.0, "maximum": 12897.2, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 9365.84, "additional_payer_notes": "212.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medical Rental Network", "methodology": "fee schedule", "standard_charge_dollar": 9365.84, "additional_payer_notes": "212.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 4417.85, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "ALLY-ALIGN (FKA SPARTAN PLAN NJ, INC.)", "plan_name": "ALLY-ALIGN (FKA SPARTAN PLAN NJ, INC.)", "methodology": "fee schedule", "standard_charge_dollar": 4638.74, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Americhoice (UHC)", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 4417.85, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Amerihealth", "plan_name": "Amerihealth Medicare", "methodology": "fee schedule", "standard_charge_dollar": 4417.85, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 6492.03, "additional_payer_notes": "146.95% of Medicare Rates" }, { "payer_name": "Clover Health", "plan_name": "Clover Medicare", "methodology": "fee schedule", "standard_charge_dollar": 4417.85, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Coventry", "plan_name": "Coventry Auto", "methodology": "fee schedule", "standard_charge_dollar": 8835.7, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Coventry", "plan_name": "Coventry Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 8835.7, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "fee schedule", "standard_charge_dollar": 6184.99, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Fairprice Healthcare Holdings", "plan_name": "Fairprice Healthcare Holdings", "methodology": "fee schedule", "standard_charge_dollar": 7068.56, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ HMO POS", "methodology": "fee schedule", "standard_charge_dollar": 7832.85, "additional_payer_notes": "177.30% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ Indemnity", "methodology": "fee schedule", "standard_charge_dollar": 7832.85, "additional_payer_notes": "177.30% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ PPO", "methodology": "fee schedule", "standard_charge_dollar": 7832.85, "additional_payer_notes": "177.30% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon Medicare", "methodology": "fee schedule", "standard_charge_dollar": 4417.85, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Military Tricare", "methodology": "fee schedule", "standard_charge_dollar": 3534.28, "additional_payer_notes": "80.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 4417.85, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 4417.85, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC All Payer (02-01-2023 to 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 5378.0 }, { "payer_name": "UHC", "plan_name": "UHC Oxford (02-01-2023 to 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 5169.0 }, { "payer_name": "UHC - Adhoc", "plan_name": "UHC - Adhoc All Payer", "methodology": "case rate", "standard_charge_dollar": 5709.0 }, { "payer_name": "UHC - Adhoc", "plan_name": "UHC - Adhoc Oxford", "methodology": "case rate", "standard_charge_dollar": 5327.0 }, { "payer_name": "Wellcare", "plan_name": "Wellcare Insurance Exchange", "methodology": "fee schedule", "standard_charge_dollar": 5964.1, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 4417.85, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellchoice", "plan_name": "WELLCHOICE HMO of NJ (Empire) Commercial (HMO / HMO POS, PPO)", "methodology": "case rate", "standard_charge_dollar": 2472.0 }, { "payer_name": "Wellchoice", "plan_name": "WELLCHOICE HMO of NJ (Empire) Commercial (Indemnity)", "methodology": "case rate", "standard_charge_dollar": 2753.0 }, { "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup Medicare", "methodology": "fee schedule", "standard_charge_dollar": 4417.85, "additional_payer_notes": "100.00% of Medicare Rates" } ] } ] }, { "description": "SPINAL FUSION AND OTHER BACK AND NECK PROCEDURES EXCEPT FOR DISC PROCEDURES- SOI : 3", "code_information": [ { "code": "3213", "type": "APR-DRG" } ], "standard_charges": [ { "setting": "inpatient", "minimum": 36522.07, "maximum": 40174.28, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Better Health - Medi Medi", "methodology": "case rate", "standard_charge_dollar": 40174.28, "additional_payer_notes": "110% of State Medicaid Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Better Health Medicaid", "methodology": "case rate", "standard_charge_dollar": 40174.28, "additional_payer_notes": "110% of State Medicaid Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "case rate", "standard_charge_dollar": 36522.07, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "UBH", "plan_name": "UBH Medicaid", "methodology": "case rate", "standard_charge_dollar": 36522.07, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicaid (02/01/2023 to 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 37252.51, "additional_payer_notes": "102% of State Medicaid Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicaid", "methodology": "case rate", "standard_charge_dollar": 36522.07, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup Medicaid", "methodology": "case rate", "standard_charge_dollar": 36522.07, "additional_payer_notes": "100% of State Medicaid Rates" } ] } ] }, { "description": "Hc Assay Of Porphobilinogen Urine Quan", "code_information": [ { "code": "84110", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 56.0, "discounted_cash": 8.0, "minimum": 5.06, "maximum": 47.6, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 17.89, "additional_payer_notes": "212.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medical Rental Network", "methodology": "fee schedule", "standard_charge_dollar": 17.89, "additional_payer_notes": "212.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 8.44, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "ALLY-ALIGN (FKA SPARTAN PLAN NJ, INC.)", "plan_name": "ALLY-ALIGN (FKA SPARTAN PLAN NJ, INC.)", "methodology": "fee schedule", "standard_charge_dollar": 8.86, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Americhoice (UHC)", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 8.44, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Amerihealth", "plan_name": "Amerihealth Medicare", "methodology": "fee schedule", "standard_charge_dollar": 8.44, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 12.24, "additional_payer_notes": "Laboratory - 145.00% of Medicare Rates" }, { "payer_name": "Clover Health", "plan_name": "Clover Medicare", "methodology": "fee schedule", "standard_charge_dollar": 8.44, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Coventry", "plan_name": "Coventry Auto", "methodology": "fee schedule", "standard_charge_dollar": 16.88, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Coventry", "plan_name": "Coventry Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 16.88, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "fee schedule", "standard_charge_dollar": 11.82, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Fairprice Healthcare Holdings", "plan_name": "Fairprice Healthcare Holdings", "methodology": "fee schedule", "standard_charge_dollar": 10.13, "additional_payer_notes": "Laboratory - 120.00% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ HMO POS", "methodology": "fee schedule", "standard_charge_dollar": 39.54, "additional_payer_notes": "177.30% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ Indemnity", "methodology": "fee schedule", "standard_charge_dollar": 39.54, "additional_payer_notes": "177.30% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ PPO", "methodology": "fee schedule", "standard_charge_dollar": 39.54, "additional_payer_notes": "177.30% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon Medicare", "methodology": "fee schedule", "standard_charge_dollar": 8.44, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Military Tricare", "methodology": "fee schedule", "standard_charge_dollar": 6.75, "additional_payer_notes": "80.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 8.44, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 8.44, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC All Payer (02-01-2023 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 5.06 }, { "payer_name": "UHC", "plan_name": "UHC Medicaid (02/01/2023 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 6.75 }, { "payer_name": "UHC", "plan_name": "UHC Oxford (02-01-2023 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 5.06 }, { "payer_name": "UHC - Adhoc", "plan_name": "UHC - Adhoc All Payer", "methodology": "fee schedule", "standard_charge_dollar": 8.44 }, { "payer_name": "UHC - Adhoc", "plan_name": "UHC - Adhoc Oxford", "methodology": "fee schedule", "standard_charge_dollar": 8.44 }, { "payer_name": "Wellcare", "plan_name": "Wellcare Insurance Exchange", "methodology": "fee schedule", "standard_charge_dollar": 11.39, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 8.44, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup Medicare", "methodology": "fee schedule", "standard_charge_dollar": 8.44, "additional_payer_notes": "100.00% of Medicare Rates" } ] } ] }, { "description": "Hc Electrocardiogram, Tracing", "code_information": [ { "code": "93005", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 293.0, "discounted_cash": 69.0, "minimum": 55.792, "maximum": 293.0, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 147.85, "additional_payer_notes": "212.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medical Rental Network", "methodology": "fee schedule", "standard_charge_dollar": 147.85, "additional_payer_notes": "212.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 69.74, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "ALLY-ALIGN (FKA SPARTAN PLAN NJ, INC.)", "plan_name": "ALLY-ALIGN (FKA SPARTAN PLAN NJ, INC.)", "methodology": "fee schedule", "standard_charge_dollar": 73.23, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Americhoice (UHC)", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 69.74, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Amerihealth", "plan_name": "Amerihealth Medicare", "methodology": "fee schedule", "standard_charge_dollar": 69.74, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 102.48, "additional_payer_notes": "146.95% of Medicare Rates" }, { "payer_name": "Clover Health", "plan_name": "Clover Medicare", "methodology": "fee schedule", "standard_charge_dollar": 69.74, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Coventry", "plan_name": "Coventry Auto", "methodology": "fee schedule", "standard_charge_dollar": 139.48, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Coventry", "plan_name": "Coventry Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 139.48, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "fee schedule", "standard_charge_dollar": 97.64, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Fairprice Healthcare Holdings", "plan_name": "Fairprice Healthcare Holdings", "methodology": "fee schedule", "standard_charge_dollar": 111.58, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ HMO POS", "methodology": "fee schedule", "standard_charge_dollar": 123.65, "additional_payer_notes": "177.30% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ Indemnity", "methodology": "fee schedule", "standard_charge_dollar": 123.65, "additional_payer_notes": "177.30% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ PPO", "methodology": "fee schedule", "standard_charge_dollar": 123.65, "additional_payer_notes": "177.30% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon Medicare", "methodology": "fee schedule", "standard_charge_dollar": 69.74, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Military Tricare", "methodology": "fee schedule", "standard_charge_dollar": 55.79, "additional_payer_notes": "80.00% of Medicare Rates" }, { "payer_name": "Keenan", "plan_name": "Keenan", "methodology": "percent of total billed charges", "standard_charge_percentage": 30.0, "median_amount": 87.9, "10th_percentile": 87.9, "90th_percentile": 87.9, "count": "37" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 69.74, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 69.74, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC All Payer (02-01-2023 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 293.0 }, { "payer_name": "UHC", "plan_name": "UHC Medicaid (02/01/2023 to 12-31-2026)", "methodology": "percent of total billed charges", "standard_charge_percentage": 19.47, "median_amount": 55.73, "10th_percentile": 55.73, "90th_percentile": 57.05, "count": "190" }, { "payer_name": "UHC", "plan_name": "UHC Oxford (02-01-2023 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 293.0 }, { "payer_name": "UHC - Adhoc", "plan_name": "UHC - Adhoc All Payer", "methodology": "fee schedule", "standard_charge_dollar": 293.0 }, { "payer_name": "UHC - Adhoc", "plan_name": "UHC - Adhoc Oxford", "methodology": "fee schedule", "standard_charge_dollar": 293.0 }, { "payer_name": "Wellcare", "plan_name": "Wellcare Insurance Exchange", "methodology": "fee schedule", "standard_charge_dollar": 94.15, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 69.74, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup Medicaid", "methodology": "percent of total billed charges", "standard_charge_percentage": 19.09, "median_amount": 54.64, "10th_percentile": 54.64, "90th_percentile": 54.64, "count": "188" }, { "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup Medicare", "methodology": "fee schedule", "standard_charge_dollar": 69.74, "additional_payer_notes": "100.00% of Medicare Rates" } ] } ] }, { "description": "Hc St Eval Speech Sound Prod Languag Comprhns, 75 Min", "code_information": [ { "code": "92523", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 822.1, "discounted_cash": 250.0, "minimum": 156.9389, "maximum": 1586.865, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 530.47, "additional_payer_notes": "212.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medical Rental Network", "methodology": "fee schedule", "standard_charge_dollar": 530.47, "additional_payer_notes": "212.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 250.22, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "ALLY-ALIGN (FKA SPARTAN PLAN NJ, INC.)", "plan_name": "ALLY-ALIGN (FKA SPARTAN PLAN NJ, INC.)", "methodology": "fee schedule", "standard_charge_dollar": 262.73, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Americhoice (UHC)", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 250.22, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Amerihealth", "plan_name": "Amerihealth Medicare", "methodology": "fee schedule", "standard_charge_dollar": 250.22, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 158.0, "additional_payer_notes": "A Indicator - 155.00% of Medicare Rates" }, { "payer_name": "Clover Health", "plan_name": "Clover Medicare", "methodology": "fee schedule", "standard_charge_dollar": 250.22, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Coventry", "plan_name": "Coventry Auto", "methodology": "fee schedule", "standard_charge_dollar": 500.44, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Coventry", "plan_name": "Coventry Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 500.44, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "fee schedule", "standard_charge_dollar": 350.31, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Fairprice Healthcare Holdings", "plan_name": "Fairprice Healthcare Holdings", "methodology": "fee schedule", "standard_charge_dollar": 400.35 }, { "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ HMO POS", "methodology": "fee schedule", "standard_charge_dollar": 580.4, "additional_payer_notes": "177.30% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ Indemnity", "methodology": "fee schedule", "standard_charge_dollar": 580.4, "additional_payer_notes": "177.30% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ PPO", "methodology": "fee schedule", "standard_charge_dollar": 580.4, "additional_payer_notes": "177.30% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon Medicare", "methodology": "fee schedule", "standard_charge_dollar": 250.22, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Military Tricare", "methodology": "fee schedule", "standard_charge_dollar": 200.18, "additional_payer_notes": "80.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 250.22, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 250.22, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC All Payer (02-01-2023 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 407.0 }, { "payer_name": "UHC", "plan_name": "UHC Oxford (02-01-2023 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 357.0 }, { "payer_name": "UHC - Adhoc", "plan_name": "UHC - Adhoc All Payer", "methodology": "fee schedule", "standard_charge_dollar": 432.0 }, { "payer_name": "UHC - Adhoc", "plan_name": "UHC - Adhoc Oxford", "methodology": "fee schedule", "standard_charge_dollar": 368.0 }, { "payer_name": "Wellcare", "plan_name": "Wellcare Insurance Exchange", "methodology": "fee schedule", "standard_charge_dollar": 337.8, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 250.22, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup Medicare", "methodology": "fee schedule", "standard_charge_dollar": 250.22, "additional_payer_notes": "100.00% of Medicare Rates" } ] } ] }, { "description": "Unlisted px arthroscopy", "code_information": [ { "code": "29999", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 7830.46, "discounted_cash": 291.0, "minimum": 233.28, "maximum": 6264.368, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 618.19, "additional_payer_notes": "212.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medical Rental Network", "methodology": "fee schedule", "standard_charge_dollar": 618.19, "additional_payer_notes": "212.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 291.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "ALLY-ALIGN (FKA SPARTAN PLAN NJ, INC.)", "plan_name": "ALLY-ALIGN (FKA SPARTAN PLAN NJ, INC.)", "methodology": "fee schedule", "standard_charge_dollar": 306.18, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Americhoice (UHC)", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 291.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Amerihealth", "plan_name": "Amerihealth Medicare", "methodology": "fee schedule", "standard_charge_dollar": 291.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 428.51, "additional_payer_notes": "146.95% of Medicare Rates" }, { "payer_name": "Clover Health", "plan_name": "Clover Medicare", "methodology": "fee schedule", "standard_charge_dollar": 291.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Coventry", "plan_name": "Coventry Auto", "methodology": "fee schedule", "standard_charge_dollar": 583.2, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Coventry", "plan_name": "Coventry Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 583.2, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "fee schedule", "standard_charge_dollar": 408.24, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Fairprice Healthcare Holdings", "plan_name": "Fairprice Healthcare Holdings", "methodology": "fee schedule", "standard_charge_dollar": 466.56, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ HMO POS", "methodology": "fee schedule", "standard_charge_dollar": 517.01, "additional_payer_notes": "177.30% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ Indemnity", "methodology": "fee schedule", "standard_charge_dollar": 517.01, "additional_payer_notes": "177.30% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ PPO", "methodology": "fee schedule", "standard_charge_dollar": 517.01, "additional_payer_notes": "177.30% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon Medicare", "methodology": "fee schedule", "standard_charge_dollar": 291.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Military Tricare", "methodology": "fee schedule", "standard_charge_dollar": 233.28, "additional_payer_notes": "80.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 291.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 291.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC All Payer (02-01-2023 to 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 3057.0 }, { "payer_name": "UHC", "plan_name": "UHC Oxford (02-01-2023 to 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 2297.0 }, { "payer_name": "UHC - Adhoc", "plan_name": "UHC - Adhoc All Payer", "methodology": "case rate", "standard_charge_dollar": 3245.0 }, { "payer_name": "UHC - Adhoc", "plan_name": "UHC - Adhoc Oxford", "methodology": "case rate", "standard_charge_dollar": 2367.0 }, { "payer_name": "Wellcare", "plan_name": "Wellcare Insurance Exchange", "methodology": "fee schedule", "standard_charge_dollar": 393.66, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 291.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellchoice", "plan_name": "WELLCHOICE HMO of NJ (Empire) Commercial (HMO / HMO POS, PPO)", "methodology": "case rate", "standard_charge_dollar": 1715.0 }, { "payer_name": "Wellchoice", "plan_name": "WELLCHOICE HMO of NJ (Empire) Commercial (Indemnity)", "methodology": "case rate", "standard_charge_dollar": 1978.0 }, { "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup Medicare", "methodology": "fee schedule", "standard_charge_dollar": 291.6, "additional_payer_notes": "100.00% of Medicare Rates" } ] } ] }, { "description": "Hc (Sup Shell C1761) Cath, Trans Intra Litho/Coro", "code_information": [ { "code": "C1761", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "payers_information": [ { "payer_name": "Horizon", "plan_name": "Horizon NJ Health Medicaid", "methodology": "percent of total billed charges", "standard_charge_percentage": 19.58, "median_amount": 6441.82, "10th_percentile": 6441.82, "90th_percentile": 6441.82, "count": "1 through 10" } ] } ] }, { "description": "NEONATE BIRTHWT >2499G, NORMAL NEWBORN OR NEONATE W OTHER PROBLEM - SOI : 3", "code_information": [ { "code": "6403", "type": "APR-DRG" } ], "standard_charges": [ { "setting": "inpatient", "minimum": 3201.93, "maximum": 3522.12, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Better Health - Medi Medi", "methodology": "case rate", "standard_charge_dollar": 3522.12, "additional_payer_notes": "110% of State Medicaid Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Better Health Medicaid", "methodology": "case rate", "standard_charge_dollar": 3522.12, "additional_payer_notes": "110% of State Medicaid Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "case rate", "standard_charge_dollar": 3201.93, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "UBH", "plan_name": "UBH Medicaid", "methodology": "case rate", "standard_charge_dollar": 3201.93, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicaid (02/01/2023 to 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 3265.97, "additional_payer_notes": "102% of State Medicaid Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicaid", "methodology": "case rate", "standard_charge_dollar": 3201.93, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup Medicaid", "methodology": "case rate", "standard_charge_dollar": 3201.93, "additional_payer_notes": "100% of State Medicaid Rates" } ] } ] }, { "description": "Hc Vaginal Delivery Only W/Postpartum Care", "code_information": [ { "code": "59410", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 6904.47, "minimum": 1318.0633, "maximum": 5523.576, "payers_information": [ { "payer_name": "Wellchoice", "plan_name": "WELLCHOICE HMO of NJ (Empire) Commercial (HMO / HMO POS, PPO)", "methodology": "case rate", "standard_charge_dollar": 1715.0 }, { "payer_name": "Wellchoice", "plan_name": "WELLCHOICE HMO of NJ (Empire) Commercial (Indemnity)", "methodology": "case rate", "standard_charge_dollar": 1978.0 } ] } ] }, { "description": "OTHER PROCEDURES OF BLOOD & BLOOD-FORMING ORGANS - SOI : 4", "code_information": [ { "code": "6514", "type": "APR-DRG" } ], "standard_charges": [ { "setting": "inpatient", "minimum": 53801.5, "maximum": 59181.65, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Better Health - Medi Medi", "methodology": "case rate", "standard_charge_dollar": 59181.65, "additional_payer_notes": "110% of State Medicaid Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Better Health Medicaid", "methodology": "case rate", "standard_charge_dollar": 59181.65, "additional_payer_notes": "110% of State Medicaid Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "case rate", "standard_charge_dollar": 53801.5, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "UBH", "plan_name": "UBH Medicaid", "methodology": "case rate", "standard_charge_dollar": 53801.5, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicaid (02/01/2023 to 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 54877.53, "additional_payer_notes": "102% of State Medicaid Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicaid", "methodology": "case rate", "standard_charge_dollar": 53801.5, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup Medicaid", "methodology": "case rate", "standard_charge_dollar": 53801.5, "additional_payer_notes": "100% of State Medicaid Rates" } ] } ] }, { "description": "Hc Asser Com Tx Grp/15 Min", "code_information": [ { "code": "H0039", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 13.88, "minimum": 2.6497, "maximum": 55.48, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 13.88, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon NJ Health Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 13.88 }, { "payer_name": "UBH", "plan_name": "UBH Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 13.88 }, { "payer_name": "UHC", "plan_name": "UHC Medicaid (02/01/2023 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 13.88 } ] } ] }, { "description": "Hc Bone Marrow Bx, Needle/Trocar", "code_information": [ { "code": "38221", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 6877.5, "discounted_cash": 1952.0, "minimum": 1312.9147, "maximum": 5502.0, "payers_information": [ { "payer_name": "Humana", "plan_name": "Humana Military Tricare", "methodology": "fee schedule", "standard_charge_dollar": 1562.02, "additional_payer_notes": "80.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1952.53, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 1952.53, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC All Payer (02-01-2023 to 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 3147.0 }, { "payer_name": "UHC", "plan_name": "UHC Oxford (02-01-2023 to 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 2297.0 }, { "payer_name": "UHC - Adhoc", "plan_name": "UHC - Adhoc All Payer", "methodology": "case rate", "standard_charge_dollar": 3341.0 }, { "payer_name": "UHC - Adhoc", "plan_name": "UHC - Adhoc Oxford", "methodology": "case rate", "standard_charge_dollar": 2367.0 }, { "payer_name": "Wellcare", "plan_name": "Wellcare Insurance Exchange", "methodology": "fee schedule", "standard_charge_dollar": 2635.92, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1952.53, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellchoice", "plan_name": "WELLCHOICE HMO of NJ (Empire) Commercial (HMO / HMO POS, PPO)", "methodology": "case rate", "standard_charge_dollar": 1715.0 }, { "payer_name": "Wellchoice", "plan_name": "WELLCHOICE HMO of NJ (Empire) Commercial (Indemnity)", "methodology": "case rate", "standard_charge_dollar": 1978.0 }, { "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1952.53, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 4139.36, "additional_payer_notes": "212.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medical Rental Network", "methodology": "fee schedule", "standard_charge_dollar": 4139.36, "additional_payer_notes": "212.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1952.53, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "ALLY-ALIGN (FKA SPARTAN PLAN NJ, INC.)", "plan_name": "ALLY-ALIGN (FKA SPARTAN PLAN NJ, INC.)", "methodology": "fee schedule", "standard_charge_dollar": 2050.16, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Americhoice (UHC)", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1952.53, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Amerihealth", "plan_name": "Amerihealth Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1952.53, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 2869.24, "additional_payer_notes": "146.95% of Medicare Rates" }, { "payer_name": "Clover Health", "plan_name": "Clover Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1952.53, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Coventry", "plan_name": "Coventry Auto", "methodology": "fee schedule", "standard_charge_dollar": 3905.06, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Coventry", "plan_name": "Coventry Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 3905.06, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "fee schedule", "standard_charge_dollar": 2733.54, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Fairprice Healthcare Holdings", "plan_name": "Fairprice Healthcare Holdings", "methodology": "fee schedule", "standard_charge_dollar": 3124.05, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ HMO POS", "methodology": "fee schedule", "standard_charge_dollar": 3461.84, "additional_payer_notes": "177.30% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ Indemnity", "methodology": "fee schedule", "standard_charge_dollar": 3461.84, "additional_payer_notes": "177.30% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ PPO", "methodology": "fee schedule", "standard_charge_dollar": 3461.84, "additional_payer_notes": "177.30% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1952.53, "additional_payer_notes": "100.00% of Medicare Rates" } ] } ] }, { "description": "OTHER DISORDERS OF THE EYE WITHOUT MCC", "code_information": [ { "code": "125", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 10429.0, "minimum": 5059.16, "maximum": 18877.9018, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "case rate", "standard_charge_dollar": 18877.9, "additional_payer_notes": "181.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medical Rental Network", "methodology": "case rate", "standard_charge_dollar": 18877.9, "additional_payer_notes": "181.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "case rate", "standard_charge_dollar": 8681.54, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "ALLY-ALIGN (FKA SPARTAN PLAN NJ, INC.)", "plan_name": "ALLY-ALIGN (FKA SPARTAN PLAN NJ, INC.)", "methodology": "case rate", "standard_charge_dollar": 10951.27, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Americhoice (UHC)", "plan_name": "UHC Medicare", "methodology": "case rate", "standard_charge_dollar": 8681.54, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Amerihealth", "plan_name": "Amerihealth Medicare", "methodology": "case rate", "standard_charge_dollar": 8681.54, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Commercial", "methodology": "case rate", "standard_charge_dollar": 11232.91 }, { "payer_name": "Clover Health", "plan_name": "Clover Medicare", "methodology": "case rate", "standard_charge_dollar": 8681.54, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Coventry", "plan_name": "Coventry Auto", "methodology": "case rate", "standard_charge_dollar": 17730.63, "additional_payer_notes": "170.00% of Medicare Rates" }, { "payer_name": "Coventry", "plan_name": "Coventry Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 17730.63, "additional_payer_notes": "170.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "case rate", "standard_charge_dollar": 13558.71, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Fairprice Healthcare Holdings", "plan_name": "Fairprice Healthcare Holdings", "methodology": "case rate", "standard_charge_dollar": 16687.65, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon Medicare", "methodology": "case rate", "standard_charge_dollar": 8681.54, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon NJ Health Medicaid", "methodology": "case rate", "standard_charge_dollar": 5059.16 }, { "payer_name": "Humana", "plan_name": "Humana Military Tricare", "methodology": "case rate", "standard_charge_dollar": 8343.82, "additional_payer_notes": "80.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 10429.78, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 10020.4 }, { "payer_name": "UBH", "plan_name": "UBH Medicare", "methodology": "case rate", "standard_charge_dollar": 8681.54, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC All Payer (02-01-2023 to 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 12942.04 }, { "payer_name": "UHC", "plan_name": "UHC Oxford (02-01-2023 to 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 11278.98 }, { "payer_name": "UHC - Adhoc", "plan_name": "UHC - Adhoc All Payer", "methodology": "case rate", "standard_charge_dollar": 13738.25 }, { "payer_name": "UHC - Adhoc", "plan_name": "UHC - Adhoc Oxford", "methodology": "case rate", "standard_charge_dollar": 11622.96 }, { "payer_name": "Wellcare", "plan_name": "Wellcare Insurance Exchange", "methodology": "case rate", "standard_charge_dollar": 14080.2, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "case rate", "standard_charge_dollar": 8681.54, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup Medicare", "methodology": "case rate", "standard_charge_dollar": 8681.54, "additional_payer_notes": "100.00% of Medicare Rates" } ] } ] }, { "description": "Hc Us Guid,Comp Repair,Pseudo-Aneur/Av Fist", "code_information": [ { "code": "76936", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 1288.54, "discounted_cash": 255.0, "minimum": 204.208, "maximum": 1095.259, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 541.15, "additional_payer_notes": "212.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medical Rental Network", "methodology": "fee schedule", "standard_charge_dollar": 541.15, "additional_payer_notes": "212.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 255.26, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "ALLY-ALIGN (FKA SPARTAN PLAN NJ, INC.)", "plan_name": "ALLY-ALIGN (FKA SPARTAN PLAN NJ, INC.)", "methodology": "fee schedule", "standard_charge_dollar": 268.02, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Americhoice (UHC)", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 255.26, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Amerihealth", "plan_name": "Amerihealth HMO", "methodology": "fee schedule", "standard_charge_dollar": 483.6 }, { "payer_name": "Amerihealth", "plan_name": "Amerihealth Medicare", "methodology": "fee schedule", "standard_charge_dollar": 255.26, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 375.1, "additional_payer_notes": "146.95% of Medicare Rates" }, { "payer_name": "Clover Health", "plan_name": "Clover Medicare", "methodology": "fee schedule", "standard_charge_dollar": 255.26, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Coventry", "plan_name": "Coventry Auto", "methodology": "fee schedule", "standard_charge_dollar": 510.52, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Coventry", "plan_name": "Coventry Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 510.52, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "fee schedule", "standard_charge_dollar": 357.36, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Fairprice Healthcare Holdings", "plan_name": "Fairprice Healthcare Holdings", "methodology": "fee schedule", "standard_charge_dollar": 408.42, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ HMO POS", "methodology": "fee schedule", "standard_charge_dollar": 452.58, "additional_payer_notes": "177.30% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ Indemnity", "methodology": "fee schedule", "standard_charge_dollar": 452.58, "additional_payer_notes": "177.30% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ PPO", "methodology": "fee schedule", "standard_charge_dollar": 452.58, "additional_payer_notes": "177.30% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon Medicare", "methodology": "fee schedule", "standard_charge_dollar": 255.26, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Military Tricare", "methodology": "fee schedule", "standard_charge_dollar": 204.21, "additional_payer_notes": "80.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 255.26, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 255.26, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC All Payer (02-01-2023 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 396.68 }, { "payer_name": "UHC", "plan_name": "UHC Oxford (02-01-2023 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 396.68 }, { "payer_name": "UHC - Adhoc", "plan_name": "UHC - Adhoc All Payer", "methodology": "fee schedule", "standard_charge_dollar": 264.45 }, { "payer_name": "UHC - Adhoc", "plan_name": "UHC - Adhoc Oxford", "methodology": "fee schedule", "standard_charge_dollar": 264.45 }, { "payer_name": "Wellcare", "plan_name": "Wellcare Insurance Exchange", "methodology": "fee schedule", "standard_charge_dollar": 344.6, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 255.26, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup Medicare", "methodology": "fee schedule", "standard_charge_dollar": 255.26, "additional_payer_notes": "100.00% of Medicare Rates" } ] } ] }, { "description": "Hc Liver Dis 10 Assays W/Nash", "code_information": [ { "code": "0003M", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 2517.0, "discounted_cash": 503.0, "minimum": 402.72, "maximum": 2139.45, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 1067.21, "additional_payer_notes": "212.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medical Rental Network", "methodology": "fee schedule", "standard_charge_dollar": 1067.21, "additional_payer_notes": "212.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 503.4, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "ALLY-ALIGN (FKA SPARTAN PLAN NJ, INC.)", "plan_name": "ALLY-ALIGN (FKA SPARTAN PLAN NJ, INC.)", "methodology": "fee schedule", "standard_charge_dollar": 528.57, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Americhoice (UHC)", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 503.4, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Amerihealth", "plan_name": "Amerihealth Medicare", "methodology": "fee schedule", "standard_charge_dollar": 503.4, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 729.93, "additional_payer_notes": "Laboratory - 145.00% of Medicare Rates" }, { "payer_name": "Clover Health", "plan_name": "Clover Medicare", "methodology": "fee schedule", "standard_charge_dollar": 503.4, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Coventry", "plan_name": "Coventry Auto", "methodology": "fee schedule", "standard_charge_dollar": 1006.8, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Coventry", "plan_name": "Coventry Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 1006.8, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "fee schedule", "standard_charge_dollar": 704.76, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Fairprice Healthcare Holdings", "plan_name": "Fairprice Healthcare Holdings", "methodology": "fee schedule", "standard_charge_dollar": 604.08, "additional_payer_notes": "Laboratory - 120.00% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ HMO POS", "methodology": "fee schedule", "standard_charge_dollar": 1777.0, "additional_payer_notes": "177.30% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ Indemnity", "methodology": "fee schedule", "standard_charge_dollar": 1777.0, "additional_payer_notes": "177.30% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ PPO", "methodology": "fee schedule", "standard_charge_dollar": 1777.0, "additional_payer_notes": "177.30% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon Medicare", "methodology": "fee schedule", "standard_charge_dollar": 503.4, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Military Tricare", "methodology": "fee schedule", "standard_charge_dollar": 402.72, "additional_payer_notes": "80.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 503.4, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 503.4, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Insurance Exchange", "methodology": "fee schedule", "standard_charge_dollar": 679.59, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 503.4, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup Medicare", "methodology": "fee schedule", "standard_charge_dollar": 503.4, "additional_payer_notes": "100.00% of Medicare Rates" } ] } ] }, { "description": "Hc Venous Cutdown <1 Y/O", "code_information": [ { "code": "36420", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 208.36, "discounted_cash": 157.0, "minimum": 39.7759, "maximum": 208.36, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 208.36, "additional_payer_notes": "212.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medical Rental Network", "methodology": "fee schedule", "standard_charge_dollar": 208.36, "additional_payer_notes": "212.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 157.29, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "ALLY-ALIGN (FKA SPARTAN PLAN NJ, INC.)", "plan_name": "ALLY-ALIGN (FKA SPARTAN PLAN NJ, INC.)", "methodology": "fee schedule", "standard_charge_dollar": 165.15, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Americhoice (UHC)", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 157.29, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Amerihealth", "plan_name": "Amerihealth Medicare", "methodology": "fee schedule", "standard_charge_dollar": 157.29, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 208.36, "additional_payer_notes": "146.95% of Medicare Rates" }, { "payer_name": "Clover Health", "plan_name": "Clover Medicare", "methodology": "fee schedule", "standard_charge_dollar": 157.29, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Coventry", "plan_name": "Coventry Auto", "methodology": "fee schedule", "standard_charge_dollar": 208.36, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Coventry", "plan_name": "Coventry Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 208.36, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "fee schedule", "standard_charge_dollar": 208.36, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Fairprice Healthcare Holdings", "plan_name": "Fairprice Healthcare Holdings", "methodology": "fee schedule", "standard_charge_dollar": 208.36, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ HMO POS", "methodology": "fee schedule", "standard_charge_dollar": 208.36, "additional_payer_notes": "177.30% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ Indemnity", "methodology": "fee schedule", "standard_charge_dollar": 208.36, "additional_payer_notes": "177.30% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ PPO", "methodology": "fee schedule", "standard_charge_dollar": 208.36, "additional_payer_notes": "177.30% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon Medicare", "methodology": "fee schedule", "standard_charge_dollar": 157.29, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Military Tricare", "methodology": "fee schedule", "standard_charge_dollar": 125.83, "additional_payer_notes": "80.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 157.29, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 157.29, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC All Payer (02-01-2023 to 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 208.36 }, { "payer_name": "UHC", "plan_name": "UHC Oxford (02-01-2023 to 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 208.36 }, { "payer_name": "UHC - Adhoc", "plan_name": "UHC - Adhoc All Payer", "methodology": "case rate", "standard_charge_dollar": 208.36 }, { "payer_name": "UHC - Adhoc", "plan_name": "UHC - Adhoc Oxford", "methodology": "case rate", "standard_charge_dollar": 208.36 }, { "payer_name": "Wellcare", "plan_name": "Wellcare Insurance Exchange", "methodology": "fee schedule", "standard_charge_dollar": 208.36, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 157.29, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup Medicare", "methodology": "fee schedule", "standard_charge_dollar": 157.29, "additional_payer_notes": "100.00% of Medicare Rates" } ] } ] }, { "description": "Hc Necropsy Limited, Single Organ", "code_information": [ { "code": "88037", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 1348.0, "minimum": 55.22, "maximum": 1145.8, "payers_information": [ { "payer_name": "UHC", "plan_name": "UHC All Payer (02-01-2023 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 55.22 }, { "payer_name": "UHC", "plan_name": "UHC Oxford (02-01-2023 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 55.22 }, { "payer_name": "UHC - Adhoc", "plan_name": "UHC - Adhoc All Payer", "methodology": "fee schedule", "standard_charge_dollar": 92.03 }, { "payer_name": "UHC - Adhoc", "plan_name": "UHC - Adhoc Oxford", "methodology": "fee schedule", "standard_charge_dollar": 92.03 } ] } ] }, { "description": "CIRRHOSIS AND ALCOHOLIC HEPATITIS WITHOUT CCMCC", "code_information": [ { "code": "434", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 9790.0, "minimum": 4065.69, "maximum": 17721.167, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "case rate", "standard_charge_dollar": 17721.17, "additional_payer_notes": "181.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medical Rental Network", "methodology": "case rate", "standard_charge_dollar": 17721.17, "additional_payer_notes": "181.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "case rate", "standard_charge_dollar": 8168.39, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "ALLY-ALIGN (FKA SPARTAN PLAN NJ, INC.)", "plan_name": "ALLY-ALIGN (FKA SPARTAN PLAN NJ, INC.)", "methodology": "case rate", "standard_charge_dollar": 10280.24, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Americhoice (UHC)", "plan_name": "UHC Medicare", "methodology": "case rate", "standard_charge_dollar": 8168.39, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Amerihealth", "plan_name": "Amerihealth Medicare", "methodology": "case rate", "standard_charge_dollar": 8168.39, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Commercial", "methodology": "case rate", "standard_charge_dollar": 10423.88 }, { "payer_name": "Clover Health", "plan_name": "Clover Medicare", "methodology": "case rate", "standard_charge_dollar": 8168.39, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Coventry", "plan_name": "Coventry Auto", "methodology": "case rate", "standard_charge_dollar": 16644.19, "additional_payer_notes": "170.00% of Medicare Rates" }, { "payer_name": "Coventry", "plan_name": "Coventry Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 16644.19, "additional_payer_notes": "170.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "case rate", "standard_charge_dollar": 12727.91, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Fairprice Healthcare Holdings", "plan_name": "Fairprice Healthcare Holdings", "methodology": "case rate", "standard_charge_dollar": 15665.12, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon Medicare", "methodology": "case rate", "standard_charge_dollar": 8168.39, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon NJ Health Medicaid", "methodology": "case rate", "standard_charge_dollar": 4065.69 }, { "payer_name": "Humana", "plan_name": "Humana Military Tricare", "methodology": "case rate", "standard_charge_dollar": 7832.56, "additional_payer_notes": "80.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 9790.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 8713.6 }, { "payer_name": "UBH", "plan_name": "UBH Medicare", "methodology": "case rate", "standard_charge_dollar": 8168.39, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC All Payer (02-01-2023 to 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 12009.9 }, { "payer_name": "UHC", "plan_name": "UHC Oxford (02-01-2023 to 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 10466.63 }, { "payer_name": "UHC - Adhoc", "plan_name": "UHC - Adhoc All Payer", "methodology": "case rate", "standard_charge_dollar": 12748.76 }, { "payer_name": "UHC - Adhoc", "plan_name": "UHC - Adhoc Oxford", "methodology": "case rate", "standard_charge_dollar": 10785.83 }, { "payer_name": "Wellcare", "plan_name": "Wellcare Insurance Exchange", "methodology": "case rate", "standard_charge_dollar": 13217.45, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "case rate", "standard_charge_dollar": 8168.39, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup Medicare", "methodology": "case rate", "standard_charge_dollar": 8168.39, "additional_payer_notes": "100.00% of Medicare Rates" } ] } ] }, { "description": "Hc X-Ray Thoracic Spine+Swim 3 Vw", "code_information": [ { "code": "72072", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 598.0, "discounted_cash": 123.0, "minimum": 61.26, "maximum": 508.3, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 262.01, "additional_payer_notes": "212.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medical Rental Network", "methodology": "fee schedule", "standard_charge_dollar": 262.01, "additional_payer_notes": "212.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 123.59, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "ALLY-ALIGN (FKA SPARTAN PLAN NJ, INC.)", "plan_name": "ALLY-ALIGN (FKA SPARTAN PLAN NJ, INC.)", "methodology": "fee schedule", "standard_charge_dollar": 129.77, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Americhoice (UHC)", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 123.59, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Amerihealth", "plan_name": "Amerihealth HMO", "methodology": "fee schedule", "standard_charge_dollar": 61.26 }, { "payer_name": "Amerihealth", "plan_name": "Amerihealth Medicare", "methodology": "fee schedule", "standard_charge_dollar": 123.59, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 181.62, "additional_payer_notes": "146.95% of Medicare Rates" }, { "payer_name": "Clover Health", "plan_name": "Clover Medicare", "methodology": "fee schedule", "standard_charge_dollar": 123.59, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Coventry", "plan_name": "Coventry Auto", "methodology": "fee schedule", "standard_charge_dollar": 247.18, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Coventry", "plan_name": "Coventry Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 247.18, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "fee schedule", "standard_charge_dollar": 173.03, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Fairprice Healthcare Holdings", "plan_name": "Fairprice Healthcare Holdings", "methodology": "fee schedule", "standard_charge_dollar": 197.74, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ HMO POS", "methodology": "fee schedule", "standard_charge_dollar": 219.13, "additional_payer_notes": "177.30% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ Indemnity", "methodology": "fee schedule", "standard_charge_dollar": 219.13, "additional_payer_notes": "177.30% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ PPO", "methodology": "fee schedule", "standard_charge_dollar": 219.13, "additional_payer_notes": "177.30% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon Medicare", "methodology": "fee schedule", "standard_charge_dollar": 123.59, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon NJ Health Medicaid", "methodology": "percent of total billed charges", "standard_charge_percentage": 19.58, "median_amount": 117.09, "10th_percentile": 117.09, "90th_percentile": 117.09, "count": "1 through 10" }, { "payer_name": "Humana", "plan_name": "Humana Military Tricare", "methodology": "fee schedule", "standard_charge_dollar": 98.87, "additional_payer_notes": "80.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 123.59, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 123.59, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC All Payer (02-01-2023 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 163.46 }, { "payer_name": "UHC", "plan_name": "UHC Medicaid (02/01/2023 to 12-31-2026)", "methodology": "percent of total billed charges", "standard_charge_percentage": 19.47, "median_amount": 113.76, "10th_percentile": 113.76, "90th_percentile": 113.76, "count": "1 through 10" }, { "payer_name": "UHC", "plan_name": "UHC Oxford (02-01-2023 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 163.46 }, { "payer_name": "UHC - Adhoc", "plan_name": "UHC - Adhoc All Payer", "methodology": "fee schedule", "standard_charge_dollar": 108.97 }, { "payer_name": "UHC - Adhoc", "plan_name": "UHC - Adhoc Oxford", "methodology": "fee schedule", "standard_charge_dollar": 108.97 }, { "payer_name": "Wellcare", "plan_name": "Wellcare Insurance Exchange", "methodology": "fee schedule", "standard_charge_dollar": 166.85, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 123.59, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup Medicare", "methodology": "fee schedule", "standard_charge_dollar": 123.59, "additional_payer_notes": "100.00% of Medicare Rates" } ] } ] }, { "description": "Hc Dna/Rna Direct Probe", "code_information": [ { "code": "87149", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 71.18, "discounted_cash": 20.0, "minimum": 12.03, "maximum": 60.503, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 42.51, "additional_payer_notes": "212.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medical Rental Network", "methodology": "fee schedule", "standard_charge_dollar": 42.51, "additional_payer_notes": "212.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 20.05, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "ALLY-ALIGN (FKA SPARTAN PLAN NJ, INC.)", "plan_name": "ALLY-ALIGN (FKA SPARTAN PLAN NJ, INC.)", "methodology": "fee schedule", "standard_charge_dollar": 21.05, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Americhoice (UHC)", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 20.05, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Amerihealth", "plan_name": "Amerihealth Medicare", "methodology": "fee schedule", "standard_charge_dollar": 20.05, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 29.07, "additional_payer_notes": "Laboratory - 145.00% of Medicare Rates" }, { "payer_name": "Clover Health", "plan_name": "Clover Medicare", "methodology": "fee schedule", "standard_charge_dollar": 20.05, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Coventry", "plan_name": "Coventry Auto", "methodology": "fee schedule", "standard_charge_dollar": 40.1, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Coventry", "plan_name": "Coventry Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 40.1, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "fee schedule", "standard_charge_dollar": 28.07, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Fairprice Healthcare Holdings", "plan_name": "Fairprice Healthcare Holdings", "methodology": "fee schedule", "standard_charge_dollar": 24.06, "additional_payer_notes": "Laboratory - 120.00% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ HMO POS", "methodology": "fee schedule", "standard_charge_dollar": 50.25, "additional_payer_notes": "177.30% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ Indemnity", "methodology": "fee schedule", "standard_charge_dollar": 50.25, "additional_payer_notes": "177.30% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ PPO", "methodology": "fee schedule", "standard_charge_dollar": 50.25, "additional_payer_notes": "177.30% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon Medicare", "methodology": "fee schedule", "standard_charge_dollar": 20.05, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Military Tricare", "methodology": "fee schedule", "standard_charge_dollar": 16.04, "additional_payer_notes": "80.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 20.05, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 20.05, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC All Payer (02-01-2023 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 12.03 }, { "payer_name": "UHC", "plan_name": "UHC Medicaid (02/01/2023 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 16.04 }, { "payer_name": "UHC", "plan_name": "UHC Oxford (02-01-2023 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 12.03 }, { "payer_name": "UHC - Adhoc", "plan_name": "UHC - Adhoc All Payer", "methodology": "fee schedule", "standard_charge_dollar": 20.05 }, { "payer_name": "UHC - Adhoc", "plan_name": "UHC - Adhoc Oxford", "methodology": "fee schedule", "standard_charge_dollar": 20.05 }, { "payer_name": "Wellcare", "plan_name": "Wellcare Insurance Exchange", "methodology": "fee schedule", "standard_charge_dollar": 27.07, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 20.05, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup Medicare", "methodology": "fee schedule", "standard_charge_dollar": 20.05, "additional_payer_notes": "100.00% of Medicare Rates" } ] } ] }, { "description": "Removegraft foot lesion - 28107 - ", "code_information": [ { "code": "28107", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 18752.5, "discounted_cash": 8578.0, "minimum": 1715.0, "maximum": 18186.0596, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 18186.06, "additional_payer_notes": "212.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medical Rental Network", "methodology": "fee schedule", "standard_charge_dollar": 18186.06, "additional_payer_notes": "212.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 8578.33, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "ALLY-ALIGN (FKA SPARTAN PLAN NJ, INC.)", "plan_name": "ALLY-ALIGN (FKA SPARTAN PLAN NJ, INC.)", "methodology": "fee schedule", "standard_charge_dollar": 9007.25, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Americhoice (UHC)", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 8578.33, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Amerihealth", "plan_name": "Amerihealth Medicare", "methodology": "fee schedule", "standard_charge_dollar": 8578.33, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 12605.86, "additional_payer_notes": "146.95% of Medicare Rates" }, { "payer_name": "Clover Health", "plan_name": "Clover Medicare", "methodology": "fee schedule", "standard_charge_dollar": 8578.33, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Coventry", "plan_name": "Coventry Auto", "methodology": "fee schedule", "standard_charge_dollar": 17156.66, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Coventry", "plan_name": "Coventry Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 17156.66, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "fee schedule", "standard_charge_dollar": 12009.66, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Fairprice Healthcare Holdings", "plan_name": "Fairprice Healthcare Holdings", "methodology": "fee schedule", "standard_charge_dollar": 13725.33, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ HMO POS", "methodology": "fee schedule", "standard_charge_dollar": 15209.38, "additional_payer_notes": "177.30% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ Indemnity", "methodology": "fee schedule", "standard_charge_dollar": 15209.38, "additional_payer_notes": "177.30% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ PPO", "methodology": "fee schedule", "standard_charge_dollar": 15209.38, "additional_payer_notes": "177.30% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon Medicare", "methodology": "fee schedule", "standard_charge_dollar": 8578.33, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Military Tricare", "methodology": "fee schedule", "standard_charge_dollar": 6862.66, "additional_payer_notes": "80.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 8578.33, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 8578.33, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC All Payer (02-01-2023 to 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 6624.0 }, { "payer_name": "UHC", "plan_name": "UHC Oxford (02-01-2023 to 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 6317.0 }, { "payer_name": "UHC - Adhoc", "plan_name": "UHC - Adhoc All Payer", "methodology": "case rate", "standard_charge_dollar": 7031.0 }, { "payer_name": "UHC - Adhoc", "plan_name": "UHC - Adhoc Oxford", "methodology": "case rate", "standard_charge_dollar": 6510.0 }, { "payer_name": "Wellcare", "plan_name": "Wellcare Insurance Exchange", "methodology": "fee schedule", "standard_charge_dollar": 11580.75, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 8578.33, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellchoice", "plan_name": "WELLCHOICE HMO of NJ (Empire) Commercial (HMO / HMO POS, PPO)", "methodology": "case rate", "standard_charge_dollar": 1715.0 }, { "payer_name": "Wellchoice", "plan_name": "WELLCHOICE HMO of NJ (Empire) Commercial (Indemnity)", "methodology": "case rate", "standard_charge_dollar": 1978.0 }, { "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup Medicare", "methodology": "fee schedule", "standard_charge_dollar": 8578.33, "additional_payer_notes": "100.00% of Medicare Rates" } ] } ] }, { "description": "SKIN DEBRIDEMENT WITH CC", "code_information": [ { "code": "571", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 21081.0, "minimum": 10633.48, "maximum": 38157.2978, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "case rate", "standard_charge_dollar": 38157.3, "additional_payer_notes": "181.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medical Rental Network", "methodology": "case rate", "standard_charge_dollar": 38157.3, "additional_payer_notes": "181.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "case rate", "standard_charge_dollar": 17234.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "ALLY-ALIGN (FKA SPARTAN PLAN NJ, INC.)", "plan_name": "ALLY-ALIGN (FKA SPARTAN PLAN NJ, INC.)", "methodology": "case rate", "standard_charge_dollar": 22135.45, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Americhoice (UHC)", "plan_name": "UHC Medicare", "methodology": "case rate", "standard_charge_dollar": 17234.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Amerihealth", "plan_name": "Amerihealth Medicare", "methodology": "case rate", "standard_charge_dollar": 17234.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Commercial", "methodology": "case rate", "standard_charge_dollar": 24717.39 }, { "payer_name": "Clover Health", "plan_name": "Clover Medicare", "methodology": "case rate", "standard_charge_dollar": 17234.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Coventry", "plan_name": "Coventry Auto", "methodology": "case rate", "standard_charge_dollar": 35838.35, "additional_payer_notes": "170.00% of Medicare Rates" }, { "payer_name": "Coventry", "plan_name": "Coventry Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 35838.35, "additional_payer_notes": "170.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "case rate", "standard_charge_dollar": 27405.79, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Fairprice Healthcare Holdings", "plan_name": "Fairprice Healthcare Holdings", "methodology": "case rate", "standard_charge_dollar": 33730.21, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon Medicare", "methodology": "case rate", "standard_charge_dollar": 17234.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon NJ Health Medicaid", "methodology": "case rate", "standard_charge_dollar": 10633.48 }, { "payer_name": "Humana", "plan_name": "Humana Military Tricare", "methodology": "case rate", "standard_charge_dollar": 16865.1, "additional_payer_notes": "80.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 21081.38, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 23409.3 }, { "payer_name": "UBH", "plan_name": "UBH Medicare", "methodology": "case rate", "standard_charge_dollar": 17234.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC All Payer (02-01-2023 to 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 28478.21 }, { "payer_name": "UHC", "plan_name": "UHC Oxford (02-01-2023 to 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 24818.76 }, { "payer_name": "UHC - Adhoc", "plan_name": "UHC - Adhoc All Payer", "methodology": "case rate", "standard_charge_dollar": 30230.22 }, { "payer_name": "UHC - Adhoc", "plan_name": "UHC - Adhoc Oxford", "methodology": "case rate", "standard_charge_dollar": 25575.65 }, { "payer_name": "Wellcare", "plan_name": "Wellcare Insurance Exchange", "methodology": "case rate", "standard_charge_dollar": 28459.86, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "case rate", "standard_charge_dollar": 17234.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup Medicare", "methodology": "case rate", "standard_charge_dollar": 17234.5, "additional_payer_notes": "100.00% of Medicare Rates" } ] } ] }, { "description": "Knee arthroscopysurgery - 29875 - ", "code_information": [ { "code": "29875", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 15418.5, "discounted_cash": 3868.0, "minimum": 1715.0, "maximum": 12334.8, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 8200.52, "additional_payer_notes": "212.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medical Rental Network", "methodology": "fee schedule", "standard_charge_dollar": 8200.52, "additional_payer_notes": "212.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3868.17, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "ALLY-ALIGN (FKA SPARTAN PLAN NJ, INC.)", "plan_name": "ALLY-ALIGN (FKA SPARTAN PLAN NJ, INC.)", "methodology": "fee schedule", "standard_charge_dollar": 4061.58, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Americhoice (UHC)", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3868.17, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Amerihealth", "plan_name": "Amerihealth Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3868.17, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 5684.28, "additional_payer_notes": "146.95% of Medicare Rates" }, { "payer_name": "Clover Health", "plan_name": "Clover Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3868.17, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Coventry", "plan_name": "Coventry Auto", "methodology": "fee schedule", "standard_charge_dollar": 7736.34, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Coventry", "plan_name": "Coventry Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 7736.34, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "fee schedule", "standard_charge_dollar": 5415.44, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Fairprice Healthcare Holdings", "plan_name": "Fairprice Healthcare Holdings", "methodology": "fee schedule", "standard_charge_dollar": 6189.07, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ HMO POS", "methodology": "fee schedule", "standard_charge_dollar": 6858.27, "additional_payer_notes": "177.30% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ Indemnity", "methodology": "fee schedule", "standard_charge_dollar": 6858.27, "additional_payer_notes": "177.30% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ PPO", "methodology": "fee schedule", "standard_charge_dollar": 6858.27, "additional_payer_notes": "177.30% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3868.17, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Military Tricare", "methodology": "fee schedule", "standard_charge_dollar": 3094.54, "additional_payer_notes": "80.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3868.17, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 3868.17, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC All Payer (02-01-2023 to 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 5378.0 }, { "payer_name": "UHC", "plan_name": "UHC Oxford (02-01-2023 to 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 5169.0 }, { "payer_name": "UHC - Adhoc", "plan_name": "UHC - Adhoc All Payer", "methodology": "case rate", "standard_charge_dollar": 5709.0 }, { "payer_name": "UHC - Adhoc", "plan_name": "UHC - Adhoc Oxford", "methodology": "case rate", "standard_charge_dollar": 5327.0 }, { "payer_name": "Wellcare", "plan_name": "Wellcare Insurance Exchange", "methodology": "fee schedule", "standard_charge_dollar": 5222.03, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3868.17, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellchoice", "plan_name": "WELLCHOICE HMO of NJ (Empire) Commercial (HMO / HMO POS, PPO)", "methodology": "case rate", "standard_charge_dollar": 1715.0 }, { "payer_name": "Wellchoice", "plan_name": "WELLCHOICE HMO of NJ (Empire) Commercial (Indemnity)", "methodology": "case rate", "standard_charge_dollar": 1978.0 }, { "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3868.17, "additional_payer_notes": "100.00% of Medicare Rates" } ] } ] }, { "description": "HIV W MULTIPLE MAJOR HIV RELATED CONDITIONS - SOI : 3", "code_information": [ { "code": "8903", "type": "APR-DRG" } ], "standard_charges": [ { "setting": "inpatient", "minimum": 16194.06, "maximum": 17813.46, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Better Health - Medi Medi", "methodology": "case rate", "standard_charge_dollar": 17813.46, "additional_payer_notes": "110% of State Medicaid Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Better Health Medicaid", "methodology": "case rate", "standard_charge_dollar": 17813.46, "additional_payer_notes": "110% of State Medicaid Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "case rate", "standard_charge_dollar": 16194.06, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "UBH", "plan_name": "UBH Medicaid", "methodology": "case rate", "standard_charge_dollar": 16194.06, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicaid (02/01/2023 to 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 16517.94, "additional_payer_notes": "102% of State Medicaid Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicaid", "methodology": "case rate", "standard_charge_dollar": 16194.06, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup Medicaid", "methodology": "case rate", "standard_charge_dollar": 16194.06, "additional_payer_notes": "100% of State Medicaid Rates" } ] } ] }, { "description": "Fusion of tibiofibular joint", "code_information": [ { "code": "27871", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 10009.92, "discounted_cash": 15177.0, "minimum": 1715.0, "maximum": 10009.92, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 10009.92, "additional_payer_notes": "212.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medical Rental Network", "methodology": "fee schedule", "standard_charge_dollar": 10009.92, "additional_payer_notes": "212.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 10009.92, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "ALLY-ALIGN (FKA SPARTAN PLAN NJ, INC.)", "plan_name": "ALLY-ALIGN (FKA SPARTAN PLAN NJ, INC.)", "methodology": "fee schedule", "standard_charge_dollar": 10009.92, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Americhoice (UHC)", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 10009.92, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Amerihealth", "plan_name": "Amerihealth Medicare", "methodology": "fee schedule", "standard_charge_dollar": 10009.92, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 10009.92, "additional_payer_notes": "146.95% of Medicare Rates" }, { "payer_name": "Clover Health", "plan_name": "Clover Medicare", "methodology": "fee schedule", "standard_charge_dollar": 10009.92, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Coventry", "plan_name": "Coventry Auto", "methodology": "fee schedule", "standard_charge_dollar": 10009.92, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Coventry", "plan_name": "Coventry Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 10009.92, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "fee schedule", "standard_charge_dollar": 10009.92, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Fairprice Healthcare Holdings", "plan_name": "Fairprice Healthcare Holdings", "methodology": "fee schedule", "standard_charge_dollar": 10009.92, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ HMO POS", "methodology": "fee schedule", "standard_charge_dollar": 10009.92, "additional_payer_notes": "177.30% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ Indemnity", "methodology": "fee schedule", "standard_charge_dollar": 10009.92, "additional_payer_notes": "177.30% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ PPO", "methodology": "fee schedule", "standard_charge_dollar": 10009.92, "additional_payer_notes": "177.30% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon Medicare", "methodology": "fee schedule", "standard_charge_dollar": 10009.92, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Military Tricare", "methodology": "fee schedule", "standard_charge_dollar": 10009.92, "additional_payer_notes": "80.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 10009.92, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 10009.92, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC All Payer (02-01-2023 to 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 6624.0 }, { "payer_name": "UHC", "plan_name": "UHC Oxford (02-01-2023 to 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 6317.0 }, { "payer_name": "UHC - Adhoc", "plan_name": "UHC - Adhoc All Payer", "methodology": "case rate", "standard_charge_dollar": 7031.0 }, { "payer_name": "UHC - Adhoc", "plan_name": "UHC - Adhoc Oxford", "methodology": "case rate", "standard_charge_dollar": 6510.0 }, { "payer_name": "Wellcare", "plan_name": "Wellcare Insurance Exchange", "methodology": "fee schedule", "standard_charge_dollar": 10009.92, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 10009.92, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellchoice", "plan_name": "WELLCHOICE HMO of NJ (Empire) Commercial (HMO / HMO POS, PPO)", "methodology": "case rate", "standard_charge_dollar": 1715.0 }, { "payer_name": "Wellchoice", "plan_name": "WELLCHOICE HMO of NJ (Empire) Commercial (Indemnity)", "methodology": "case rate", "standard_charge_dollar": 1978.0 }, { "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup Medicare", "methodology": "fee schedule", "standard_charge_dollar": 10009.92, "additional_payer_notes": "100.00% of Medicare Rates" } ] } ] }, { "description": "DENTAL AND ORAL DISEASES WITH MCC", "code_information": [ { "code": "157", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 21396.0, "minimum": 10446.77, "maximum": 38728.3347, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "case rate", "standard_charge_dollar": 38728.33, "additional_payer_notes": "181.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medical Rental Network", "methodology": "case rate", "standard_charge_dollar": 38728.33, "additional_payer_notes": "181.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "case rate", "standard_charge_dollar": 17487.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "ALLY-ALIGN (FKA SPARTAN PLAN NJ, INC.)", "plan_name": "ALLY-ALIGN (FKA SPARTAN PLAN NJ, INC.)", "methodology": "case rate", "standard_charge_dollar": 22466.71, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Americhoice (UHC)", "plan_name": "UHC Medicare", "methodology": "case rate", "standard_charge_dollar": 17487.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Amerihealth", "plan_name": "Amerihealth Medicare", "methodology": "case rate", "standard_charge_dollar": 17487.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Commercial", "methodology": "case rate", "standard_charge_dollar": 25116.78 }, { "payer_name": "Clover Health", "plan_name": "Clover Medicare", "methodology": "case rate", "standard_charge_dollar": 17487.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Coventry", "plan_name": "Coventry Auto", "methodology": "case rate", "standard_charge_dollar": 36374.68, "additional_payer_notes": "170.00% of Medicare Rates" }, { "payer_name": "Coventry", "plan_name": "Coventry Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 36374.68, "additional_payer_notes": "170.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "case rate", "standard_charge_dollar": 27815.93, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Fairprice Healthcare Holdings", "plan_name": "Fairprice Healthcare Holdings", "methodology": "case rate", "standard_charge_dollar": 34234.99, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon Medicare", "methodology": "case rate", "standard_charge_dollar": 17487.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon NJ Health Medicaid", "methodology": "case rate", "standard_charge_dollar": 10446.77 }, { "payer_name": "Humana", "plan_name": "Humana Military Tricare", "methodology": "case rate", "standard_charge_dollar": 17117.5, "additional_payer_notes": "80.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 21396.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 21185.0 }, { "payer_name": "UBH", "plan_name": "UBH Medicare", "methodology": "case rate", "standard_charge_dollar": 17487.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC All Payer (02-01-2023 to 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 28938.38 }, { "payer_name": "UHC", "plan_name": "UHC Oxford (02-01-2023 to 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 25219.79 }, { "payer_name": "UHC - Adhoc", "plan_name": "UHC - Adhoc All Payer", "methodology": "case rate", "standard_charge_dollar": 30718.7 }, { "payer_name": "UHC - Adhoc", "plan_name": "UHC - Adhoc Oxford", "methodology": "case rate", "standard_charge_dollar": 25988.92 }, { "payer_name": "Wellcare", "plan_name": "Wellcare Insurance Exchange", "methodology": "case rate", "standard_charge_dollar": 28885.77, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "case rate", "standard_charge_dollar": 17487.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup Medicare", "methodology": "case rate", "standard_charge_dollar": 17487.8, "additional_payer_notes": "100.00% of Medicare Rates" } ] } ] }, { "description": "Hc Assay, Free Hydroxyproline", "code_information": [ { "code": "83500", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 162.0, "discounted_cash": 22.0, "minimum": 13.59, "maximum": 137.7, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 48.02, "additional_payer_notes": "212.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medical Rental Network", "methodology": "fee schedule", "standard_charge_dollar": 48.02, "additional_payer_notes": "212.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 22.65, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "ALLY-ALIGN (FKA SPARTAN PLAN NJ, INC.)", "plan_name": "ALLY-ALIGN (FKA SPARTAN PLAN NJ, INC.)", "methodology": "fee schedule", "standard_charge_dollar": 23.78, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Americhoice (UHC)", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 22.65, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Amerihealth", "plan_name": "Amerihealth Medicare", "methodology": "fee schedule", "standard_charge_dollar": 22.65, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 32.84, "additional_payer_notes": "Laboratory - 145.00% of Medicare Rates" }, { "payer_name": "Clover Health", "plan_name": "Clover Medicare", "methodology": "fee schedule", "standard_charge_dollar": 22.65, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Coventry", "plan_name": "Coventry Auto", "methodology": "fee schedule", "standard_charge_dollar": 45.3, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Coventry", "plan_name": "Coventry Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 45.3, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "fee schedule", "standard_charge_dollar": 31.71, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Fairprice Healthcare Holdings", "plan_name": "Fairprice Healthcare Holdings", "methodology": "fee schedule", "standard_charge_dollar": 27.18, "additional_payer_notes": "Laboratory - 120.00% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ HMO POS", "methodology": "fee schedule", "standard_charge_dollar": 114.37, "additional_payer_notes": "177.30% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ Indemnity", "methodology": "fee schedule", "standard_charge_dollar": 114.37, "additional_payer_notes": "177.30% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ PPO", "methodology": "fee schedule", "standard_charge_dollar": 114.37, "additional_payer_notes": "177.30% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon Medicare", "methodology": "fee schedule", "standard_charge_dollar": 22.65, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Military Tricare", "methodology": "fee schedule", "standard_charge_dollar": 18.12, "additional_payer_notes": "80.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 22.65, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 22.65, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC All Payer (02-01-2023 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 13.59 }, { "payer_name": "UHC", "plan_name": "UHC Medicaid (02/01/2023 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 18.12 }, { "payer_name": "UHC", "plan_name": "UHC Oxford (02-01-2023 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 13.59 }, { "payer_name": "UHC - Adhoc", "plan_name": "UHC - Adhoc All Payer", "methodology": "fee schedule", "standard_charge_dollar": 22.65 }, { "payer_name": "UHC - Adhoc", "plan_name": "UHC - Adhoc Oxford", "methodology": "fee schedule", "standard_charge_dollar": 22.65 }, { "payer_name": "Wellcare", "plan_name": "Wellcare Insurance Exchange", "methodology": "fee schedule", "standard_charge_dollar": 30.58, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 22.65, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup Medicare", "methodology": "fee schedule", "standard_charge_dollar": 22.65, "additional_payer_notes": "100.00% of Medicare Rates" } ] } ] }, { "description": "VERTEBRAL AND INTERVERTEBRAL SPINAL PROCEDURES INCLUDING DISC PROCEDURES- SOI : 4", "code_information": [ { "code": "3104", "type": "APR-DRG" } ], "standard_charges": [ { "setting": "inpatient", "minimum": 48365.68, "maximum": 53202.25, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Better Health - Medi Medi", "methodology": "case rate", "standard_charge_dollar": 53202.25, "additional_payer_notes": "110% of State Medicaid Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Better Health Medicaid", "methodology": "case rate", "standard_charge_dollar": 53202.25, "additional_payer_notes": "110% of State Medicaid Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "case rate", "standard_charge_dollar": 48365.68, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "UBH", "plan_name": "UBH Medicaid", "methodology": "case rate", "standard_charge_dollar": 48365.68, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicaid (02/01/2023 to 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 49333.0, "additional_payer_notes": "102% of State Medicaid Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicaid", "methodology": "case rate", "standard_charge_dollar": 48365.68, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup Medicaid", "methodology": "case rate", "standard_charge_dollar": 48365.68, "additional_payer_notes": "100% of State Medicaid Rates" } ] } ] }, { "description": "Hc Assay Of Amphetamines - G0480 - 30100323", "code_information": [ { "code": "G0480", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 44.0, "discounted_cash": 114.0, "minimum": 8.3996, "maximum": 754.8, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 44.0, "additional_payer_notes": "212.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medical Rental Network", "methodology": "fee schedule", "standard_charge_dollar": 44.0, "additional_payer_notes": "212.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 44.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "ALLY-ALIGN (FKA SPARTAN PLAN NJ, INC.)", "plan_name": "ALLY-ALIGN (FKA SPARTAN PLAN NJ, INC.)", "methodology": "fee schedule", "standard_charge_dollar": 44.0, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Americhoice (UHC)", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 44.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Amerihealth", "plan_name": "Amerihealth Medicare", "methodology": "fee schedule", "standard_charge_dollar": 44.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 44.0, "additional_payer_notes": "Laboratory - 145.00% of Medicare Rates" }, { "payer_name": "Clover Health", "plan_name": "Clover Medicare", "methodology": "fee schedule", "standard_charge_dollar": 44.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Coventry", "plan_name": "Coventry Auto", "methodology": "fee schedule", "standard_charge_dollar": 44.0, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Coventry", "plan_name": "Coventry Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 44.0, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "fee schedule", "standard_charge_dollar": 44.0, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Fairprice Healthcare Holdings", "plan_name": "Fairprice Healthcare Holdings", "methodology": "fee schedule", "standard_charge_dollar": 44.0, "additional_payer_notes": "Laboratory - 120.00% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ HMO POS", "methodology": "fee schedule", "standard_charge_dollar": 31.06, "additional_payer_notes": "177.30% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ Indemnity", "methodology": "fee schedule", "standard_charge_dollar": 31.06, "additional_payer_notes": "177.30% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ PPO", "methodology": "fee schedule", "standard_charge_dollar": 31.06, "additional_payer_notes": "177.30% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon Medicare", "methodology": "fee schedule", "standard_charge_dollar": 44.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Military Tricare", "methodology": "fee schedule", "standard_charge_dollar": 44.0, "additional_payer_notes": "80.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 44.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 44.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC All Payer (02-01-2023 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 44.0 }, { "payer_name": "UHC", "plan_name": "UHC Medicaid (02/01/2023 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 44.0 }, { "payer_name": "UHC", "plan_name": "UHC Oxford (02-01-2023 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 44.0 }, { "payer_name": "UHC - Adhoc", "plan_name": "UHC - Adhoc All Payer", "methodology": "fee schedule", "standard_charge_dollar": 44.0 }, { "payer_name": "UHC - Adhoc", "plan_name": "UHC - Adhoc Oxford", "methodology": "fee schedule", "standard_charge_dollar": 44.0 }, { "payer_name": "Wellcare", "plan_name": "Wellcare Insurance Exchange", "methodology": "fee schedule", "standard_charge_dollar": 44.0, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 44.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup Medicare", "methodology": "fee schedule", "standard_charge_dollar": 44.0, "additional_payer_notes": "100.00% of Medicare Rates" } ] } ] }, { "description": "Hc Insert Picc W/O Sub-Q Port <5 Y/O", "code_information": [ { "code": "36568", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 2311.04, "discounted_cash": 1860.0, "minimum": 441.1775, "maximum": 2311.04, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 2311.04, "additional_payer_notes": "212.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medical Rental Network", "methodology": "fee schedule", "standard_charge_dollar": 2311.04, "additional_payer_notes": "212.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1860.97, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "ALLY-ALIGN (FKA SPARTAN PLAN NJ, INC.)", "plan_name": "ALLY-ALIGN (FKA SPARTAN PLAN NJ, INC.)", "methodology": "fee schedule", "standard_charge_dollar": 1954.02, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Americhoice (UHC)", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1860.97, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Amerihealth", "plan_name": "Amerihealth Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1860.97, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 2311.04, "additional_payer_notes": "146.95% of Medicare Rates" }, { "payer_name": "Clover Health", "plan_name": "Clover Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1860.97, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Coventry", "plan_name": "Coventry Auto", "methodology": "fee schedule", "standard_charge_dollar": 2311.04, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Coventry", "plan_name": "Coventry Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 2311.04, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "fee schedule", "standard_charge_dollar": 2311.04, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Fairprice Healthcare Holdings", "plan_name": "Fairprice Healthcare Holdings", "methodology": "fee schedule", "standard_charge_dollar": 2311.04, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ HMO POS", "methodology": "fee schedule", "standard_charge_dollar": 2311.04, "additional_payer_notes": "177.30% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ Indemnity", "methodology": "fee schedule", "standard_charge_dollar": 2311.04, "additional_payer_notes": "177.30% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ PPO", "methodology": "fee schedule", "standard_charge_dollar": 2311.04, "additional_payer_notes": "177.30% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1860.97, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Military Tricare", "methodology": "fee schedule", "standard_charge_dollar": 1488.78, "additional_payer_notes": "80.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1860.97, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 1860.97, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC All Payer (02-01-2023 to 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 2311.04 }, { "payer_name": "UHC", "plan_name": "UHC Oxford (02-01-2023 to 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 2297.0 }, { "payer_name": "UHC - Adhoc", "plan_name": "UHC - Adhoc All Payer", "methodology": "case rate", "standard_charge_dollar": 2311.04 }, { "payer_name": "UHC - Adhoc", "plan_name": "UHC - Adhoc Oxford", "methodology": "case rate", "standard_charge_dollar": 2311.04 }, { "payer_name": "Wellcare", "plan_name": "Wellcare Insurance Exchange", "methodology": "fee schedule", "standard_charge_dollar": 2311.04, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1860.97, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellchoice", "plan_name": "WELLCHOICE HMO of NJ (Empire) Commercial (HMO / HMO POS, PPO)", "methodology": "case rate", "standard_charge_dollar": 1715.0 }, { "payer_name": "Wellchoice", "plan_name": "WELLCHOICE HMO of NJ (Empire) Commercial (Indemnity)", "methodology": "case rate", "standard_charge_dollar": 1978.0 }, { "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1860.97, "additional_payer_notes": "100.00% of Medicare Rates" } ] } ] }, { "description": "Hc Sigmoidoscopy,Biopsy", "code_information": [ { "code": "45331", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 3752.03, "discounted_cash": 1099.0, "minimum": 716.2625, "maximum": 3341.0, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 2330.73, "additional_payer_notes": "212.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medical Rental Network", "methodology": "fee schedule", "standard_charge_dollar": 2330.73, "additional_payer_notes": "212.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1099.4, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "ALLY-ALIGN (FKA SPARTAN PLAN NJ, INC.)", "plan_name": "ALLY-ALIGN (FKA SPARTAN PLAN NJ, INC.)", "methodology": "fee schedule", "standard_charge_dollar": 1154.37, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Americhoice (UHC)", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1099.4, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Amerihealth", "plan_name": "Amerihealth Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1099.4, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 1615.57, "additional_payer_notes": "146.95% of Medicare Rates" }, { "payer_name": "Clover Health", "plan_name": "Clover Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1099.4, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Coventry", "plan_name": "Coventry Auto", "methodology": "fee schedule", "standard_charge_dollar": 2198.8, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Coventry", "plan_name": "Coventry Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 2198.8, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "fee schedule", "standard_charge_dollar": 1539.16, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Fairprice Healthcare Holdings", "plan_name": "Fairprice Healthcare Holdings", "methodology": "fee schedule", "standard_charge_dollar": 1759.04, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ HMO POS", "methodology": "fee schedule", "standard_charge_dollar": 1949.24, "additional_payer_notes": "177.30% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ Indemnity", "methodology": "fee schedule", "standard_charge_dollar": 1949.24, "additional_payer_notes": "177.30% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ PPO", "methodology": "fee schedule", "standard_charge_dollar": 1949.24, "additional_payer_notes": "177.30% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1099.4, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Military Tricare", "methodology": "fee schedule", "standard_charge_dollar": 879.52, "additional_payer_notes": "80.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1099.4, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 1099.4, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC All Payer (02-01-2023 to 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 3147.0 }, { "payer_name": "UHC", "plan_name": "UHC Oxford (02-01-2023 to 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 2297.0 }, { "payer_name": "UHC - Adhoc", "plan_name": "UHC - Adhoc All Payer", "methodology": "case rate", "standard_charge_dollar": 3341.0 }, { "payer_name": "UHC - Adhoc", "plan_name": "UHC - Adhoc Oxford", "methodology": "case rate", "standard_charge_dollar": 2367.0 }, { "payer_name": "Wellcare", "plan_name": "Wellcare Insurance Exchange", "methodology": "fee schedule", "standard_charge_dollar": 1484.19, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1099.4, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1099.4, "additional_payer_notes": "100.00% of Medicare Rates" } ] } ] }, { "description": "ACUTE MYOCARDIAL INFARCTION, DISCHARGED ALIVE WITHOUT CCMCC", "code_information": [ { "code": "282", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 9913.0, "minimum": 4677.01, "maximum": 17942.892, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "case rate", "standard_charge_dollar": 17942.89, "additional_payer_notes": "181.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medical Rental Network", "methodology": "case rate", "standard_charge_dollar": 17942.89, "additional_payer_notes": "181.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "case rate", "standard_charge_dollar": 8266.75, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "ALLY-ALIGN (FKA SPARTAN PLAN NJ, INC.)", "plan_name": "ALLY-ALIGN (FKA SPARTAN PLAN NJ, INC.)", "methodology": "case rate", "standard_charge_dollar": 10408.86, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Americhoice (UHC)", "plan_name": "UHC Medicare", "methodology": "case rate", "standard_charge_dollar": 8266.75, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Amerihealth", "plan_name": "Amerihealth Medicare", "methodology": "case rate", "standard_charge_dollar": 8266.75, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Commercial", "methodology": "case rate", "standard_charge_dollar": 10578.95 }, { "payer_name": "Clover Health", "plan_name": "Clover Medicare", "methodology": "case rate", "standard_charge_dollar": 8266.75, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Coventry", "plan_name": "Coventry Auto", "methodology": "case rate", "standard_charge_dollar": 16852.44, "additional_payer_notes": "170.00% of Medicare Rates" }, { "payer_name": "Coventry", "plan_name": "Coventry Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 16852.44, "additional_payer_notes": "170.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "case rate", "standard_charge_dollar": 12887.16, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Fairprice Healthcare Holdings", "plan_name": "Fairprice Healthcare Holdings", "methodology": "case rate", "standard_charge_dollar": 15861.12, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon Medicare", "methodology": "case rate", "standard_charge_dollar": 8266.75, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon NJ Health Medicaid", "methodology": "case rate", "standard_charge_dollar": 4677.01 }, { "payer_name": "Humana", "plan_name": "Humana Military Tricare", "methodology": "case rate", "standard_charge_dollar": 7930.56, "additional_payer_notes": "80.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 9913.2, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 12074.3 }, { "payer_name": "UBH", "plan_name": "UBH Medicare", "methodology": "case rate", "standard_charge_dollar": 8266.75, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC All Payer (02-01-2023 to 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 12188.57 }, { "payer_name": "UHC", "plan_name": "UHC Oxford (02-01-2023 to 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 10622.34 }, { "payer_name": "UHC - Adhoc", "plan_name": "UHC - Adhoc All Payer", "methodology": "case rate", "standard_charge_dollar": 12938.43 }, { "payer_name": "UHC - Adhoc", "plan_name": "UHC - Adhoc Oxford", "methodology": "case rate", "standard_charge_dollar": 10946.29 }, { "payer_name": "Wellcare", "plan_name": "Wellcare Insurance Exchange", "methodology": "case rate", "standard_charge_dollar": 13382.82, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "case rate", "standard_charge_dollar": 8266.75, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup Medicare", "methodology": "case rate", "standard_charge_dollar": 8266.75, "additional_payer_notes": "100.00% of Medicare Rates" } ] } ] }, { "description": "Hc Exc Bartholins Gland/Cyst", "code_information": [ { "code": "56740", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 6957.78, "discounted_cash": 3826.0, "minimum": 1328.2402, "maximum": 12580.08, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 6957.78, "additional_payer_notes": "212.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medical Rental Network", "methodology": "fee schedule", "standard_charge_dollar": 6957.78, "additional_payer_notes": "212.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3826.95, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "ALLY-ALIGN (FKA SPARTAN PLAN NJ, INC.)", "plan_name": "ALLY-ALIGN (FKA SPARTAN PLAN NJ, INC.)", "methodology": "fee schedule", "standard_charge_dollar": 4018.3, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Americhoice (UHC)", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3826.95, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Amerihealth", "plan_name": "Amerihealth Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3826.95, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 5623.7, "additional_payer_notes": "146.95% of Medicare Rates" }, { "payer_name": "Clover Health", "plan_name": "Clover Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3826.95, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Coventry", "plan_name": "Coventry Auto", "methodology": "fee schedule", "standard_charge_dollar": 6957.78, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Coventry", "plan_name": "Coventry Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 6957.78, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "fee schedule", "standard_charge_dollar": 5357.73, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Fairprice Healthcare Holdings", "plan_name": "Fairprice Healthcare Holdings", "methodology": "fee schedule", "standard_charge_dollar": 6123.12, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ HMO POS", "methodology": "fee schedule", "standard_charge_dollar": 6785.18, "additional_payer_notes": "177.30% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ Indemnity", "methodology": "fee schedule", "standard_charge_dollar": 6785.18, "additional_payer_notes": "177.30% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ PPO", "methodology": "fee schedule", "standard_charge_dollar": 6785.18, "additional_payer_notes": "177.30% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3826.95, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Military Tricare", "methodology": "fee schedule", "standard_charge_dollar": 3061.56, "additional_payer_notes": "80.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3826.95, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 3826.95, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC All Payer (02-01-2023 to 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 4415.0 }, { "payer_name": "UHC", "plan_name": "UHC Oxford (02-01-2023 to 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 4020.0 }, { "payer_name": "UHC - Adhoc", "plan_name": "UHC - Adhoc All Payer", "methodology": "case rate", "standard_charge_dollar": 4687.0 }, { "payer_name": "UHC - Adhoc", "plan_name": "UHC - Adhoc Oxford", "methodology": "case rate", "standard_charge_dollar": 4143.0 }, { "payer_name": "Wellcare", "plan_name": "Wellcare Insurance Exchange", "methodology": "fee schedule", "standard_charge_dollar": 5166.38, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3826.95, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellchoice", "plan_name": "WELLCHOICE HMO of NJ (Empire) Commercial (HMO / HMO POS, PPO)", "methodology": "case rate", "standard_charge_dollar": 1715.0 }, { "payer_name": "Wellchoice", "plan_name": "WELLCHOICE HMO of NJ (Empire) Commercial (Indemnity)", "methodology": "case rate", "standard_charge_dollar": 1978.0 }, { "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3826.95, "additional_payer_notes": "100.00% of Medicare Rates" } ] } ] }, { "description": "Hc Ercp Biliary/Panc Duct Stent Exchnge W/Dil&Wire", "code_information": [ { "code": "43276", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 23397.1, "discounted_cash": 7177.0, "minimum": 4020.0, "maximum": 19887.535, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 15215.32, "additional_payer_notes": "212.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medical Rental Network", "methodology": "fee schedule", "standard_charge_dollar": 15215.32, "additional_payer_notes": "212.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 7177.04, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "ALLY-ALIGN (FKA SPARTAN PLAN NJ, INC.)", "plan_name": "ALLY-ALIGN (FKA SPARTAN PLAN NJ, INC.)", "methodology": "fee schedule", "standard_charge_dollar": 7535.89, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Americhoice (UHC)", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 7177.04, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Amerihealth", "plan_name": "Amerihealth Medicare", "methodology": "fee schedule", "standard_charge_dollar": 7177.04, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 10546.66, "additional_payer_notes": "146.95% of Medicare Rates" }, { "payer_name": "Clover Health", "plan_name": "Clover Medicare", "methodology": "fee schedule", "standard_charge_dollar": 7177.04, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Coventry", "plan_name": "Coventry Auto", "methodology": "fee schedule", "standard_charge_dollar": 14354.08, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Coventry", "plan_name": "Coventry Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 14354.08, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "fee schedule", "standard_charge_dollar": 10047.86, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Fairprice Healthcare Holdings", "plan_name": "Fairprice Healthcare Holdings", "methodology": "fee schedule", "standard_charge_dollar": 11483.26, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ HMO POS", "methodology": "fee schedule", "standard_charge_dollar": 12724.89, "additional_payer_notes": "177.30% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ Indemnity", "methodology": "fee schedule", "standard_charge_dollar": 12724.89, "additional_payer_notes": "177.30% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ PPO", "methodology": "fee schedule", "standard_charge_dollar": 12724.89, "additional_payer_notes": "177.30% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon Medicare", "methodology": "fee schedule", "standard_charge_dollar": 7177.04, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Military Tricare", "methodology": "fee schedule", "standard_charge_dollar": 5741.63, "additional_payer_notes": "80.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 7177.04, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 7177.04, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC All Payer (02-01-2023 to 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 4415.0 }, { "payer_name": "UHC", "plan_name": "UHC Oxford (02-01-2023 to 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 4020.0 }, { "payer_name": "UHC - Adhoc", "plan_name": "UHC - Adhoc All Payer", "methodology": "case rate", "standard_charge_dollar": 4687.0 }, { "payer_name": "UHC - Adhoc", "plan_name": "UHC - Adhoc Oxford", "methodology": "case rate", "standard_charge_dollar": 4143.0 }, { "payer_name": "Wellcare", "plan_name": "Wellcare Insurance Exchange", "methodology": "fee schedule", "standard_charge_dollar": 9689.0, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 7177.04, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup Medicare", "methodology": "fee schedule", "standard_charge_dollar": 7177.04, "additional_payer_notes": "100.00% of Medicare Rates" } ] } ] }, { "description": "SPLENIC PROCEDURES WITHOUT CCMCC", "code_information": [ { "code": "801", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 23616.0, "minimum": 9718.06, "maximum": 42746.5347, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "case rate", "standard_charge_dollar": 42746.53, "additional_payer_notes": "181.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medical Rental Network", "methodology": "case rate", "standard_charge_dollar": 42746.53, "additional_payer_notes": "181.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "case rate", "standard_charge_dollar": 19270.4, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "ALLY-ALIGN (FKA SPARTAN PLAN NJ, INC.)", "plan_name": "ALLY-ALIGN (FKA SPARTAN PLAN NJ, INC.)", "methodology": "case rate", "standard_charge_dollar": 24797.71, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Americhoice (UHC)", "plan_name": "UHC Medicare", "methodology": "case rate", "standard_charge_dollar": 19270.4, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Amerihealth", "plan_name": "Amerihealth Medicare", "methodology": "case rate", "standard_charge_dollar": 19270.4, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Commercial", "methodology": "case rate", "standard_charge_dollar": 27927.21 }, { "payer_name": "Clover Health", "plan_name": "Clover Medicare", "methodology": "case rate", "standard_charge_dollar": 19270.4, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Coventry", "plan_name": "Coventry Auto", "methodology": "case rate", "standard_charge_dollar": 40148.68, "additional_payer_notes": "170.00% of Medicare Rates" }, { "payer_name": "Coventry", "plan_name": "Coventry Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 40148.68, "additional_payer_notes": "170.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "case rate", "standard_charge_dollar": 30701.93, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Fairprice Healthcare Holdings", "plan_name": "Fairprice Healthcare Holdings", "methodology": "case rate", "standard_charge_dollar": 37786.99, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon Medicare", "methodology": "case rate", "standard_charge_dollar": 19270.4, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon NJ Health Medicaid", "methodology": "case rate", "standard_charge_dollar": 9718.06 }, { "payer_name": "Humana", "plan_name": "Humana Military Tricare", "methodology": "case rate", "standard_charge_dollar": 18893.5, "additional_payer_notes": "80.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 23616.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 23885.1 }, { "payer_name": "UBH", "plan_name": "UBH Medicare", "methodology": "case rate", "standard_charge_dollar": 19270.4, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC All Payer (02-01-2023 to 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 32176.42 }, { "payer_name": "UHC", "plan_name": "UHC Oxford (02-01-2023 to 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 28041.74 }, { "payer_name": "UHC - Adhoc", "plan_name": "UHC - Adhoc All Payer", "methodology": "case rate", "standard_charge_dollar": 34155.95 }, { "payer_name": "UHC - Adhoc", "plan_name": "UHC - Adhoc Oxford", "methodology": "case rate", "standard_charge_dollar": 28896.93 }, { "payer_name": "Wellcare", "plan_name": "Wellcare Insurance Exchange", "methodology": "case rate", "standard_charge_dollar": 31882.77, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "case rate", "standard_charge_dollar": 19270.4, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup Medicare", "methodology": "case rate", "standard_charge_dollar": 19270.4, "additional_payer_notes": "100.00% of Medicare Rates" } ] } ] }, { "description": "NEONATE, TRANSFERRED <5 DAYS OLD, NOT BORN HERE - SOI : 4", "code_information": [ { "code": "5804", "type": "APR-DRG" } ], "standard_charges": [ { "setting": "inpatient", "minimum": 13287.32, "maximum": 14616.06, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Better Health - Medi Medi", "methodology": "case rate", "standard_charge_dollar": 14616.06, "additional_payer_notes": "110% of State Medicaid Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Better Health Medicaid", "methodology": "case rate", "standard_charge_dollar": 14616.06, "additional_payer_notes": "110% of State Medicaid Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "case rate", "standard_charge_dollar": 13287.32, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "UBH", "plan_name": "UBH Medicaid", "methodology": "case rate", "standard_charge_dollar": 13287.32, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicaid (02/01/2023 to 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 13553.07, "additional_payer_notes": "102% of State Medicaid Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicaid", "methodology": "case rate", "standard_charge_dollar": 13287.32, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup Medicaid", "methodology": "case rate", "standard_charge_dollar": 13287.32, "additional_payer_notes": "100% of State Medicaid Rates" } ] } ] }, { "description": "Hc Msh6 Gene Known Variants", "code_information": [ { "code": "81299", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 308.0, "discounted_cash": 308.0, "minimum": 58.7972, "maximum": 308.0, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 308.0, "additional_payer_notes": "212.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medical Rental Network", "methodology": "fee schedule", "standard_charge_dollar": 308.0, "additional_payer_notes": "212.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 308.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "ALLY-ALIGN (FKA SPARTAN PLAN NJ, INC.)", "plan_name": "ALLY-ALIGN (FKA SPARTAN PLAN NJ, INC.)", "methodology": "fee schedule", "standard_charge_dollar": 308.0, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Americhoice (UHC)", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 308.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Amerihealth", "plan_name": "Amerihealth Medicare", "methodology": "fee schedule", "standard_charge_dollar": 308.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 308.0, "additional_payer_notes": "A Indicator - 155.00% of Medicare Rates" }, { "payer_name": "Clover Health", "plan_name": "Clover Medicare", "methodology": "fee schedule", "standard_charge_dollar": 308.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Coventry", "plan_name": "Coventry Auto", "methodology": "fee schedule", "standard_charge_dollar": 308.0, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Coventry", "plan_name": "Coventry Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 308.0, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "fee schedule", "standard_charge_dollar": 308.0, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Fairprice Healthcare Holdings", "plan_name": "Fairprice Healthcare Holdings", "methodology": "fee schedule", "standard_charge_dollar": 308.0, "additional_payer_notes": "Laboratory - 120.00% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ HMO POS", "methodology": "fee schedule", "standard_charge_dollar": 217.45, "additional_payer_notes": "177.30% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ Indemnity", "methodology": "fee schedule", "standard_charge_dollar": 217.45, "additional_payer_notes": "177.30% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ PPO", "methodology": "fee schedule", "standard_charge_dollar": 217.45, "additional_payer_notes": "177.30% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon Medicare", "methodology": "fee schedule", "standard_charge_dollar": 308.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon NJ Health Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 246.4 }, { "payer_name": "Humana", "plan_name": "Humana Military Tricare", "methodology": "fee schedule", "standard_charge_dollar": 246.4, "additional_payer_notes": "80.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 308.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 308.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC All Payer (02-01-2023 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 184.8 }, { "payer_name": "UHC", "plan_name": "UHC Medicaid (02/01/2023 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 246.4 }, { "payer_name": "UHC", "plan_name": "UHC Oxford (02-01-2023 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 184.8 }, { "payer_name": "UHC - Adhoc", "plan_name": "UHC - Adhoc All Payer", "methodology": "fee schedule", "standard_charge_dollar": 308.0 }, { "payer_name": "UHC - Adhoc", "plan_name": "UHC - Adhoc Oxford", "methodology": "fee schedule", "standard_charge_dollar": 308.0 }, { "payer_name": "Wellcare", "plan_name": "Wellcare Insurance Exchange", "methodology": "fee schedule", "standard_charge_dollar": 308.0, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 308.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup Medicare", "methodology": "fee schedule", "standard_charge_dollar": 308.0, "additional_payer_notes": "100.00% of Medicare Rates" } ] } ] }, { "description": "PERCUTANEOUS AND OTHER INTRACARDIAC PROCEDURES WITH MCC", "code_information": [ { "code": "273", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 49232.0, "minimum": 22807.43, "maximum": 89111.6214, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "case rate", "standard_charge_dollar": 89111.62, "additional_payer_notes": "181.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medical Rental Network", "methodology": "case rate", "standard_charge_dollar": 89111.62, "additional_payer_notes": "181.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "case rate", "standard_charge_dollar": 39839.4, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "ALLY-ALIGN (FKA SPARTAN PLAN NJ, INC.)", "plan_name": "ALLY-ALIGN (FKA SPARTAN PLAN NJ, INC.)", "methodology": "case rate", "standard_charge_dollar": 51694.59, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Americhoice (UHC)", "plan_name": "UHC Medicare", "methodology": "case rate", "standard_charge_dollar": 39839.4, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Amerihealth", "plan_name": "Amerihealth Medicare", "methodology": "case rate", "standard_charge_dollar": 39839.4, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Commercial", "methodology": "case rate", "standard_charge_dollar": 60356.07 }, { "payer_name": "Clover Health", "plan_name": "Clover Medicare", "methodology": "case rate", "standard_charge_dollar": 39839.4, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Coventry", "plan_name": "Coventry Auto", "methodology": "case rate", "standard_charge_dollar": 83696.0, "additional_payer_notes": "170.00% of Medicare Rates" }, { "payer_name": "Coventry", "plan_name": "Coventry Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 83696.0, "additional_payer_notes": "170.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "case rate", "standard_charge_dollar": 64002.82, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Fairprice Healthcare Holdings", "plan_name": "Fairprice Healthcare Holdings", "methodology": "case rate", "standard_charge_dollar": 78772.7, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon Medicare", "methodology": "case rate", "standard_charge_dollar": 39839.4, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon NJ Health Medicaid", "methodology": "case rate", "standard_charge_dollar": 22807.43 }, { "payer_name": "Humana", "plan_name": "Humana Military Tricare", "methodology": "case rate", "standard_charge_dollar": 39386.35, "additional_payer_notes": "80.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 49232.94, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 65578.8 }, { "payer_name": "UBH", "plan_name": "UBH Medicare", "methodology": "case rate", "standard_charge_dollar": 39839.4, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC All Payer (02-01-2023 to 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 69539.43 }, { "payer_name": "UHC", "plan_name": "UHC Oxford (02-01-2023 to 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 60603.6 }, { "payer_name": "UHC - Adhoc", "plan_name": "UHC - Adhoc All Payer", "methodology": "case rate", "standard_charge_dollar": 73817.57 }, { "payer_name": "UHC - Adhoc", "plan_name": "UHC - Adhoc Oxford", "methodology": "case rate", "standard_charge_dollar": 62451.82 }, { "payer_name": "Wellcare", "plan_name": "Wellcare Insurance Exchange", "methodology": "case rate", "standard_charge_dollar": 66464.47, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "case rate", "standard_charge_dollar": 39839.4, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup Medicare", "methodology": "case rate", "standard_charge_dollar": 39839.4, "additional_payer_notes": "100.00% of Medicare Rates" } ] } ] }, { "description": "Hc Evoked Auditory Tst Complete", "code_information": [ { "code": "92588", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 1557.0, "discounted_cash": 441.0, "minimum": 297.2313, "maximum": 1557.0, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 935.24, "additional_payer_notes": "212.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medical Rental Network", "methodology": "fee schedule", "standard_charge_dollar": 935.24, "additional_payer_notes": "212.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 441.15, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "ALLY-ALIGN (FKA SPARTAN PLAN NJ, INC.)", "plan_name": "ALLY-ALIGN (FKA SPARTAN PLAN NJ, INC.)", "methodology": "fee schedule", "standard_charge_dollar": 463.21, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Americhoice (UHC)", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 441.15, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Amerihealth", "plan_name": "Amerihealth Medicare", "methodology": "fee schedule", "standard_charge_dollar": 441.15, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 648.27, "additional_payer_notes": "146.95% of Medicare Rates" }, { "payer_name": "Clover Health", "plan_name": "Clover Medicare", "methodology": "fee schedule", "standard_charge_dollar": 441.15, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Coventry", "plan_name": "Coventry Auto", "methodology": "fee schedule", "standard_charge_dollar": 882.3, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Coventry", "plan_name": "Coventry Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 882.3, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "fee schedule", "standard_charge_dollar": 617.61, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Fairprice Healthcare Holdings", "plan_name": "Fairprice Healthcare Holdings", "methodology": "fee schedule", "standard_charge_dollar": 705.84, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ HMO POS", "methodology": "fee schedule", "standard_charge_dollar": 782.16, "additional_payer_notes": "177.30% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ Indemnity", "methodology": "fee schedule", "standard_charge_dollar": 782.16, "additional_payer_notes": "177.30% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ PPO", "methodology": "fee schedule", "standard_charge_dollar": 782.16, "additional_payer_notes": "177.30% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon Medicare", "methodology": "fee schedule", "standard_charge_dollar": 441.15, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Military Tricare", "methodology": "fee schedule", "standard_charge_dollar": 352.92, "additional_payer_notes": "80.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 441.15, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 441.15, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC All Payer (02-01-2023 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 1557.0 }, { "payer_name": "UHC", "plan_name": "UHC Oxford (02-01-2023 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 1385.0 }, { "payer_name": "UHC - Adhoc", "plan_name": "UHC - Adhoc All Payer", "methodology": "fee schedule", "standard_charge_dollar": 1557.0 }, { "payer_name": "UHC - Adhoc", "plan_name": "UHC - Adhoc Oxford", "methodology": "fee schedule", "standard_charge_dollar": 1427.0 }, { "payer_name": "Wellcare", "plan_name": "Wellcare Insurance Exchange", "methodology": "fee schedule", "standard_charge_dollar": 595.55, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 441.15, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup Medicare", "methodology": "fee schedule", "standard_charge_dollar": 441.15, "additional_payer_notes": "100.00% of Medicare Rates" } ] } ] }, { "description": "Hc Assay Of Testosterone", "code_information": [ { "code": "84402", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 230.0, "discounted_cash": 25.0, "minimum": 15.28, "maximum": 195.5, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 54.0, "additional_payer_notes": "212.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medical Rental Network", "methodology": "fee schedule", "standard_charge_dollar": 54.0, "additional_payer_notes": "212.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 25.47, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "ALLY-ALIGN (FKA SPARTAN PLAN NJ, INC.)", "plan_name": "ALLY-ALIGN (FKA SPARTAN PLAN NJ, INC.)", "methodology": "fee schedule", "standard_charge_dollar": 26.74, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Americhoice (UHC)", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 25.47, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Amerihealth", "plan_name": "Amerihealth Medicare", "methodology": "fee schedule", "standard_charge_dollar": 25.47, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 36.93, "additional_payer_notes": "Laboratory - 145.00% of Medicare Rates" }, { "payer_name": "Clover Health", "plan_name": "Clover Medicare", "methodology": "fee schedule", "standard_charge_dollar": 25.47, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Coventry", "plan_name": "Coventry Auto", "methodology": "fee schedule", "standard_charge_dollar": 50.94, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Coventry", "plan_name": "Coventry Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 50.94, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "fee schedule", "standard_charge_dollar": 35.66, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Fairprice Healthcare Holdings", "plan_name": "Fairprice Healthcare Holdings", "methodology": "fee schedule", "standard_charge_dollar": 30.56, "additional_payer_notes": "Laboratory - 120.00% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ HMO POS", "methodology": "fee schedule", "standard_charge_dollar": 162.38, "additional_payer_notes": "177.30% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ Indemnity", "methodology": "fee schedule", "standard_charge_dollar": 162.38, "additional_payer_notes": "177.30% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ PPO", "methodology": "fee schedule", "standard_charge_dollar": 162.38, "additional_payer_notes": "177.30% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon Medicare", "methodology": "fee schedule", "standard_charge_dollar": 25.47, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Military Tricare", "methodology": "fee schedule", "standard_charge_dollar": 20.38, "additional_payer_notes": "80.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 25.47, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 25.47, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC All Payer (02-01-2023 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 15.28 }, { "payer_name": "UHC", "plan_name": "UHC Medicaid (02/01/2023 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 20.38 }, { "payer_name": "UHC", "plan_name": "UHC Oxford (02-01-2023 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 15.28 }, { "payer_name": "UHC - Adhoc", "plan_name": "UHC - Adhoc All Payer", "methodology": "fee schedule", "standard_charge_dollar": 25.47 }, { "payer_name": "UHC - Adhoc", "plan_name": "UHC - Adhoc Oxford", "methodology": "fee schedule", "standard_charge_dollar": 25.47 }, { "payer_name": "Wellcare", "plan_name": "Wellcare Insurance Exchange", "methodology": "fee schedule", "standard_charge_dollar": 34.38, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 25.47, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup Medicare", "methodology": "fee schedule", "standard_charge_dollar": 25.47, "additional_payer_notes": "100.00% of Medicare Rates" } ] } ] }, { "description": "Hc Cv Strs Tst Xers&/Or Rx Cont Ecg W/Si&R (93015)", "code_information": [ { "code": "93015", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 1156.75, "minimum": 220.8236, "maximum": 1156.75, "payers_information": [ { "payer_name": "UHC", "plan_name": "UHC All Payer (02-01-2023 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 1156.75 }, { "payer_name": "UHC", "plan_name": "UHC Oxford (02-01-2023 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 1156.75 }, { "payer_name": "UHC - Adhoc", "plan_name": "UHC - Adhoc All Payer", "methodology": "fee schedule", "standard_charge_dollar": 1156.75 }, { "payer_name": "UHC - Adhoc", "plan_name": "UHC - Adhoc Oxford", "methodology": "fee schedule", "standard_charge_dollar": 1156.75 } ] } ] }, { "description": "Hc Nm Nuclear Diagnostic Exam Unlisted", "code_information": [ { "code": "78999", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 498.98, "discounted_cash": 472.0, "minimum": 95.2553, "maximum": 498.98, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 498.98, "additional_payer_notes": "212.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medical Rental Network", "methodology": "fee schedule", "standard_charge_dollar": 498.98, "additional_payer_notes": "212.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 472.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "ALLY-ALIGN (FKA SPARTAN PLAN NJ, INC.)", "plan_name": "ALLY-ALIGN (FKA SPARTAN PLAN NJ, INC.)", "methodology": "fee schedule", "standard_charge_dollar": 496.23, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Americhoice (UHC)", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 472.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Amerihealth", "plan_name": "Amerihealth Medicare", "methodology": "fee schedule", "standard_charge_dollar": 472.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 498.98, "additional_payer_notes": "146.95% of Medicare Rates" }, { "payer_name": "Clover Health", "plan_name": "Clover Medicare", "methodology": "fee schedule", "standard_charge_dollar": 472.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Coventry", "plan_name": "Coventry Auto", "methodology": "fee schedule", "standard_charge_dollar": 498.98, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Coventry", "plan_name": "Coventry Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 498.98, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "fee schedule", "standard_charge_dollar": 498.98, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Fairprice Healthcare Holdings", "plan_name": "Fairprice Healthcare Holdings", "methodology": "fee schedule", "standard_charge_dollar": 498.98, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ HMO POS", "methodology": "fee schedule", "standard_charge_dollar": 498.98, "additional_payer_notes": "177.30% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ Indemnity", "methodology": "fee schedule", "standard_charge_dollar": 498.98, "additional_payer_notes": "177.30% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ PPO", "methodology": "fee schedule", "standard_charge_dollar": 498.98, "additional_payer_notes": "177.30% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon Medicare", "methodology": "fee schedule", "standard_charge_dollar": 472.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Military Tricare", "methodology": "fee schedule", "standard_charge_dollar": 378.08, "additional_payer_notes": "80.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 472.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 472.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC All Payer (02-01-2023 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 498.98 }, { "payer_name": "UHC", "plan_name": "UHC Oxford (02-01-2023 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 498.98 }, { "payer_name": "UHC - Adhoc", "plan_name": "UHC - Adhoc All Payer", "methodology": "fee schedule", "standard_charge_dollar": 377.12 }, { "payer_name": "UHC - Adhoc", "plan_name": "UHC - Adhoc Oxford", "methodology": "fee schedule", "standard_charge_dollar": 377.12 }, { "payer_name": "Wellcare", "plan_name": "Wellcare Insurance Exchange", "methodology": "fee schedule", "standard_charge_dollar": 498.98, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 472.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup Medicare", "methodology": "fee schedule", "standard_charge_dollar": 472.6, "additional_payer_notes": "100.00% of Medicare Rates" } ] } ] }, { "description": "Hc Cessation Thrombolytic Thrpy W/Catheter Removal", "code_information": [ { "code": "37214", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 5468.15, "discounted_cash": 3732.0, "minimum": 1043.8698, "maximum": 5468.15, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 5468.15, "additional_payer_notes": "212.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medical Rental Network", "methodology": "fee schedule", "standard_charge_dollar": 5468.15, "additional_payer_notes": "212.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3732.79, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "ALLY-ALIGN (FKA SPARTAN PLAN NJ, INC.)", "plan_name": "ALLY-ALIGN (FKA SPARTAN PLAN NJ, INC.)", "methodology": "fee schedule", "standard_charge_dollar": 3919.43, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Americhoice (UHC)", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3732.79, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Amerihealth", "plan_name": "Amerihealth Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3732.79, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 5468.15, "additional_payer_notes": "146.95% of Medicare Rates" }, { "payer_name": "Clover Health", "plan_name": "Clover Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3732.79, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Coventry", "plan_name": "Coventry Auto", "methodology": "fee schedule", "standard_charge_dollar": 5468.15, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Coventry", "plan_name": "Coventry Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 5468.15, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "fee schedule", "standard_charge_dollar": 5225.91, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Fairprice Healthcare Holdings", "plan_name": "Fairprice Healthcare Holdings", "methodology": "fee schedule", "standard_charge_dollar": 5468.15, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ HMO POS", "methodology": "fee schedule", "standard_charge_dollar": 5468.15, "additional_payer_notes": "177.30% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ Indemnity", "methodology": "fee schedule", "standard_charge_dollar": 5468.15, "additional_payer_notes": "177.30% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ PPO", "methodology": "fee schedule", "standard_charge_dollar": 5468.15, "additional_payer_notes": "177.30% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3732.79, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Military Tricare", "methodology": "fee schedule", "standard_charge_dollar": 2986.23, "additional_payer_notes": "80.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3732.79, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 3732.79, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC All Payer (02-01-2023 to 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 3147.0 }, { "payer_name": "UHC", "plan_name": "UHC Oxford (02-01-2023 to 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 2297.0 }, { "payer_name": "UHC - Adhoc", "plan_name": "UHC - Adhoc All Payer", "methodology": "case rate", "standard_charge_dollar": 3341.0 }, { "payer_name": "UHC - Adhoc", "plan_name": "UHC - Adhoc Oxford", "methodology": "case rate", "standard_charge_dollar": 2367.0 }, { "payer_name": "Wellcare", "plan_name": "Wellcare Insurance Exchange", "methodology": "fee schedule", "standard_charge_dollar": 5039.27, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3732.79, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellchoice", "plan_name": "WELLCHOICE HMO of NJ (Empire) Commercial (HMO / HMO POS, PPO)", "methodology": "case rate", "standard_charge_dollar": 2472.0 }, { "payer_name": "Wellchoice", "plan_name": "WELLCHOICE HMO of NJ (Empire) Commercial (Indemnity)", "methodology": "case rate", "standard_charge_dollar": 2753.0 }, { "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3732.79, "additional_payer_notes": "100.00% of Medicare Rates" } ] } ] }, { "description": "NEONATE BIRTHWT 1000-1249G W OR WO OTHER SIGNIFICANT CONDITION - SOI : 3", "code_information": [ { "code": "6033", "type": "APR-DRG" } ], "standard_charges": [ { "setting": "inpatient", "minimum": 79469.98, "maximum": 87416.98, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Better Health - Medi Medi", "methodology": "case rate", "standard_charge_dollar": 87416.98, "additional_payer_notes": "110% of State Medicaid Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Better Health Medicaid", "methodology": "case rate", "standard_charge_dollar": 87416.98, "additional_payer_notes": "110% of State Medicaid Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "case rate", "standard_charge_dollar": 79469.98, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "UBH", "plan_name": "UBH Medicaid", "methodology": "case rate", "standard_charge_dollar": 79469.98, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicaid (02/01/2023 to 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 81059.38, "additional_payer_notes": "102% of State Medicaid Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicaid", "methodology": "case rate", "standard_charge_dollar": 79469.98, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup Medicaid", "methodology": "case rate", "standard_charge_dollar": 79469.98, "additional_payer_notes": "100% of State Medicaid Rates" } ] } ] }, { "description": "Hc Colonoscopy,Biopsy", "code_information": [ { "code": "45380", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 4898.95, "discounted_cash": 1414.0, "minimum": 935.2096, "maximum": 4164.1075, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 2999.1, "additional_payer_notes": "212.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medical Rental Network", "methodology": "fee schedule", "standard_charge_dollar": 2999.1, "additional_payer_notes": "212.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1414.67, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "ALLY-ALIGN (FKA SPARTAN PLAN NJ, INC.)", "plan_name": "ALLY-ALIGN (FKA SPARTAN PLAN NJ, INC.)", "methodology": "fee schedule", "standard_charge_dollar": 1485.4, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Americhoice (UHC)", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1414.67, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Amerihealth", "plan_name": "Amerihealth HMO", "methodology": "percent of total billed charges", "standard_charge_percentage": 50.0, "standard_charge_algorithm": "Not To Exceed $9088", "additional_payer_notes": "Not to exceed limits in contract for this procedure", "median_amount": 4898.95, "10th_percentile": 4898.95, "90th_percentile": 4898.95, "count": "1 through 10" }, { "payer_name": "Amerihealth", "plan_name": "Amerihealth Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1414.67, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 2078.86, "additional_payer_notes": "146.95% of Medicare Rates" }, { "payer_name": "Clover Health", "plan_name": "Clover Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1414.67, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Coventry", "plan_name": "Coventry Auto", "methodology": "fee schedule", "standard_charge_dollar": 2829.34, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Coventry", "plan_name": "Coventry Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 2829.34, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "fee schedule", "standard_charge_dollar": 1980.54, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Fairprice Healthcare Holdings", "plan_name": "Fairprice Healthcare Holdings", "methodology": "fee schedule", "standard_charge_dollar": 2263.47, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ HMO POS", "methodology": "fee schedule", "standard_charge_dollar": 2508.21, "additional_payer_notes": "177.30% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ Indemnity", "methodology": "fee schedule", "standard_charge_dollar": 2508.21, "additional_payer_notes": "177.30% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ PPO", "methodology": "fee schedule", "standard_charge_dollar": 2508.21, "additional_payer_notes": "177.30% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1414.67, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon NJ Health Medicaid", "methodology": "percent of total billed charges", "standard_charge_percentage": 19.58, "median_amount": 959.21, "10th_percentile": 959.21, "90th_percentile": 959.21, "count": "98" }, { "payer_name": "Humana", "plan_name": "Humana Military Tricare", "methodology": "fee schedule", "standard_charge_dollar": 1131.74, "additional_payer_notes": "80.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1414.67, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 1414.67, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC All Payer (02-01-2023 to 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 3912.0 }, { "payer_name": "UHC", "plan_name": "UHC Medicaid (02/01/2023 to 12-31-2026)", "methodology": "percent of total billed charges", "standard_charge_percentage": 19.47, "median_amount": 931.92, "10th_percentile": 931.92, "90th_percentile": 931.92, "count": "31" }, { "payer_name": "UHC", "plan_name": "UHC Oxford (02-01-2023 to 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 3676.0 }, { "payer_name": "UHC - Adhoc", "plan_name": "UHC - Adhoc All Payer", "methodology": "case rate", "standard_charge_dollar": 4153.0 }, { "payer_name": "UHC - Adhoc", "plan_name": "UHC - Adhoc Oxford", "methodology": "case rate", "standard_charge_dollar": 3788.0 }, { "payer_name": "Wellcare", "plan_name": "Wellcare Insurance Exchange", "methodology": "fee schedule", "standard_charge_dollar": 1909.8, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1414.67, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup Medicaid", "methodology": "percent of total billed charges", "standard_charge_percentage": 19.09, "median_amount": 913.65, "10th_percentile": 913.65, "90th_percentile": 935.21, "count": "25" }, { "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1414.67, "additional_payer_notes": "100.00% of Medicare Rates" } ] } ] }, { "description": "POSTOPERATIVE OR POST-TRAUMATIC INFECTIONS WITH O.R. PROCEDURES WITH MCC", "code_information": [ { "code": "856", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 54123.0, "minimum": 28026.45, "maximum": 97963.7884, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "case rate", "standard_charge_dollar": 97963.79, "additional_payer_notes": "181.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medical Rental Network", "methodology": "case rate", "standard_charge_dollar": 97963.79, "additional_payer_notes": "181.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "case rate", "standard_charge_dollar": 43766.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "ALLY-ALIGN (FKA SPARTAN PLAN NJ, INC.)", "plan_name": "ALLY-ALIGN (FKA SPARTAN PLAN NJ, INC.)", "methodology": "case rate", "standard_charge_dollar": 56829.82, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Americhoice (UHC)", "plan_name": "UHC Medicare", "methodology": "case rate", "standard_charge_dollar": 43766.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Amerihealth", "plan_name": "Amerihealth Medicare", "methodology": "case rate", "standard_charge_dollar": 43766.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Commercial", "methodology": "case rate", "standard_charge_dollar": 66547.48 }, { "payer_name": "Clover Health", "plan_name": "Clover Medicare", "methodology": "case rate", "standard_charge_dollar": 43766.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Coventry", "plan_name": "Coventry Auto", "methodology": "case rate", "standard_charge_dollar": 92010.19, "additional_payer_notes": "170.00% of Medicare Rates" }, { "payer_name": "Coventry", "plan_name": "Coventry Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 92010.19, "additional_payer_notes": "170.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "case rate", "standard_charge_dollar": 70360.73, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Fairprice Healthcare Holdings", "plan_name": "Fairprice Healthcare Holdings", "methodology": "case rate", "standard_charge_dollar": 86597.82, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon Medicare", "methodology": "case rate", "standard_charge_dollar": 43766.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon NJ Health Medicaid", "methodology": "case rate", "standard_charge_dollar": 28026.45 }, { "payer_name": "Humana", "plan_name": "Humana Military Tricare", "methodology": "case rate", "standard_charge_dollar": 43298.91, "additional_payer_notes": "80.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 54123.64, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 48265.6 }, { "payer_name": "UBH", "plan_name": "UBH Medicare", "methodology": "case rate", "standard_charge_dollar": 43766.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC All Payer (02-01-2023 to 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 76672.89 }, { "payer_name": "UHC", "plan_name": "UHC Oxford (02-01-2023 to 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 66820.4 }, { "payer_name": "UHC - Adhoc", "plan_name": "UHC - Adhoc All Payer", "methodology": "case rate", "standard_charge_dollar": 81389.89 }, { "payer_name": "UHC - Adhoc", "plan_name": "UHC - Adhoc Oxford", "methodology": "case rate", "standard_charge_dollar": 68858.22 }, { "payer_name": "Wellcare", "plan_name": "Wellcare Insurance Exchange", "methodology": "case rate", "standard_charge_dollar": 73066.91, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "case rate", "standard_charge_dollar": 43766.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup Medicare", "methodology": "case rate", "standard_charge_dollar": 43766.5, "additional_payer_notes": "100.00% of Medicare Rates" } ] } ] }, { "description": "Hc Removal Foot Fb Subq", "code_information": [ { "code": "28190", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 2159.45, "discounted_cash": 837.0, "minimum": 412.239, "maximum": 13848.0, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 1774.76, "additional_payer_notes": "212.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medical Rental Network", "methodology": "fee schedule", "standard_charge_dollar": 1774.76, "additional_payer_notes": "212.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 837.15, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "ALLY-ALIGN (FKA SPARTAN PLAN NJ, INC.)", "plan_name": "ALLY-ALIGN (FKA SPARTAN PLAN NJ, INC.)", "methodology": "fee schedule", "standard_charge_dollar": 879.01, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Americhoice (UHC)", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 837.15, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Amerihealth", "plan_name": "Amerihealth Medicare", "methodology": "fee schedule", "standard_charge_dollar": 837.15, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 1230.19, "additional_payer_notes": "146.95% of Medicare Rates" }, { "payer_name": "Clover Health", "plan_name": "Clover Medicare", "methodology": "fee schedule", "standard_charge_dollar": 837.15, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Coventry", "plan_name": "Coventry Auto", "methodology": "fee schedule", "standard_charge_dollar": 1674.3, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Coventry", "plan_name": "Coventry Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 1674.3, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "fee schedule", "standard_charge_dollar": 1172.01, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Fairprice Healthcare Holdings", "plan_name": "Fairprice Healthcare Holdings", "methodology": "fee schedule", "standard_charge_dollar": 1339.44, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ HMO POS", "methodology": "fee schedule", "standard_charge_dollar": 1484.27, "additional_payer_notes": "177.30% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ Indemnity", "methodology": "fee schedule", "standard_charge_dollar": 1484.27, "additional_payer_notes": "177.30% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ PPO", "methodology": "fee schedule", "standard_charge_dollar": 1484.27, "additional_payer_notes": "177.30% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon Medicare", "methodology": "fee schedule", "standard_charge_dollar": 837.15, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Military Tricare", "methodology": "fee schedule", "standard_charge_dollar": 669.72, "additional_payer_notes": "80.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 837.15, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 837.15, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC All Payer (02-01-2023 to 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 2159.45 }, { "payer_name": "UHC", "plan_name": "UHC Oxford (02-01-2023 to 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 2159.45 }, { "payer_name": "UHC - Adhoc", "plan_name": "UHC - Adhoc All Payer", "methodology": "case rate", "standard_charge_dollar": 2159.45 }, { "payer_name": "UHC - Adhoc", "plan_name": "UHC - Adhoc Oxford", "methodology": "case rate", "standard_charge_dollar": 2159.45 }, { "payer_name": "Wellcare", "plan_name": "Wellcare Insurance Exchange", "methodology": "fee schedule", "standard_charge_dollar": 1130.15, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 837.15, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellchoice", "plan_name": "WELLCHOICE HMO of NJ (Empire) Commercial (HMO / HMO POS, PPO)", "methodology": "case rate", "standard_charge_dollar": 1715.0 }, { "payer_name": "Wellchoice", "plan_name": "WELLCHOICE HMO of NJ (Empire) Commercial (Indemnity)", "methodology": "case rate", "standard_charge_dollar": 1978.0 }, { "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup Medicare", "methodology": "fee schedule", "standard_charge_dollar": 837.15, "additional_payer_notes": "100.00% of Medicare Rates" } ] } ] }, { "description": "Hc Assay Of Serotonin", "code_information": [ { "code": "84260", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 171.0, "discounted_cash": 30.0, "minimum": 18.59, "maximum": 145.35, "payers_information": [ { "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ PPO", "methodology": "fee schedule", "standard_charge_dollar": 120.73, "additional_payer_notes": "177.30% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon Medicare", "methodology": "fee schedule", "standard_charge_dollar": 30.98, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Military Tricare", "methodology": "fee schedule", "standard_charge_dollar": 24.78, "additional_payer_notes": "80.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 30.98, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 30.98, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC All Payer (02-01-2023 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 18.59 }, { "payer_name": "UHC", "plan_name": "UHC Medicaid (02/01/2023 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 24.78 }, { "payer_name": "UHC", "plan_name": "UHC Oxford (02-01-2023 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 18.59 }, { "payer_name": "UHC - Adhoc", "plan_name": "UHC - Adhoc All Payer", "methodology": "fee schedule", "standard_charge_dollar": 30.98 }, { "payer_name": "UHC - Adhoc", "plan_name": "UHC - Adhoc Oxford", "methodology": "fee schedule", "standard_charge_dollar": 30.98 }, { "payer_name": "Wellcare", "plan_name": "Wellcare Insurance Exchange", "methodology": "fee schedule", "standard_charge_dollar": 41.82, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 30.98, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup Medicare", "methodology": "fee schedule", "standard_charge_dollar": 30.98, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 65.68, "additional_payer_notes": "212.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medical Rental Network", "methodology": "fee schedule", "standard_charge_dollar": 65.68, "additional_payer_notes": "212.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 30.98, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "ALLY-ALIGN (FKA SPARTAN PLAN NJ, INC.)", "plan_name": "ALLY-ALIGN (FKA SPARTAN PLAN NJ, INC.)", "methodology": "fee schedule", "standard_charge_dollar": 32.53, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Americhoice (UHC)", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 30.98, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Amerihealth", "plan_name": "Amerihealth Medicare", "methodology": "fee schedule", "standard_charge_dollar": 30.98, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 44.92, "additional_payer_notes": "Laboratory - 145.00% of Medicare Rates" }, { "payer_name": "Clover Health", "plan_name": "Clover Medicare", "methodology": "fee schedule", "standard_charge_dollar": 30.98, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Coventry", "plan_name": "Coventry Auto", "methodology": "fee schedule", "standard_charge_dollar": 61.96, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Coventry", "plan_name": "Coventry Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 61.96, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "fee schedule", "standard_charge_dollar": 43.37, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Fairprice Healthcare Holdings", "plan_name": "Fairprice Healthcare Holdings", "methodology": "fee schedule", "standard_charge_dollar": 37.18, "additional_payer_notes": "Laboratory - 120.00% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ HMO POS", "methodology": "fee schedule", "standard_charge_dollar": 120.73, "additional_payer_notes": "177.30% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ Indemnity", "methodology": "fee schedule", "standard_charge_dollar": 120.73, "additional_payer_notes": "177.30% of Medicare Rates" } ] } ] }, { "description": "EXTERNAL HEART ASSIST SYSTEMS- SOI : 4", "code_information": [ { "code": "1784", "type": "APR-DRG" } ], "standard_charges": [ { "setting": "inpatient", "minimum": 97580.88, "maximum": 107338.96, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Better Health - Medi Medi", "methodology": "case rate", "standard_charge_dollar": 107338.96, "additional_payer_notes": "110% of State Medicaid Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Better Health Medicaid", "methodology": "case rate", "standard_charge_dollar": 107338.96, "additional_payer_notes": "110% of State Medicaid Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "case rate", "standard_charge_dollar": 97580.88, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "UBH", "plan_name": "UBH Medicaid", "methodology": "case rate", "standard_charge_dollar": 97580.88, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicaid (02/01/2023 to 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 99532.49, "additional_payer_notes": "102% of State Medicaid Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicaid", "methodology": "case rate", "standard_charge_dollar": 97580.88, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup Medicaid", "methodology": "case rate", "standard_charge_dollar": 97580.88, "additional_payer_notes": "100% of State Medicaid Rates" } ] } ] }, { "description": "Hc Debridement Open Wound Ea Addl 20 Sq Cm", "code_information": [ { "code": "97598", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 1318.21, "minimum": 251.6463, "maximum": 1318.21, "payers_information": [ { "payer_name": "UHC", "plan_name": "UHC All Payer (02-01-2023 to 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 1318.21 }, { "payer_name": "UHC", "plan_name": "UHC Oxford (02-01-2023 to 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 1318.21 }, { "payer_name": "UHC - Adhoc", "plan_name": "UHC - Adhoc All Payer", "methodology": "case rate", "standard_charge_dollar": 1318.21 }, { "payer_name": "UHC - Adhoc", "plan_name": "UHC - Adhoc Oxford", "methodology": "case rate", "standard_charge_dollar": 1318.21 }, { "payer_name": "Wellchoice", "plan_name": "WELLCHOICE HMO of NJ (Empire) Commercial (HMO / HMO POS, PPO)", "methodology": "case rate", "standard_charge_dollar": 1318.21 }, { "payer_name": "Wellchoice", "plan_name": "WELLCHOICE HMO of NJ (Empire) Commercial (Indemnity)", "methodology": "case rate", "standard_charge_dollar": 1318.21 } ] } ] }, { "description": "Hc Assay, Serum Cholinesterase", "code_information": [ { "code": "82480", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 32.0, "discounted_cash": 7.0, "minimum": 4.72, "maximum": 27.2, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 16.68, "additional_payer_notes": "212.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medical Rental Network", "methodology": "fee schedule", "standard_charge_dollar": 16.68, "additional_payer_notes": "212.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 7.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "ALLY-ALIGN (FKA SPARTAN PLAN NJ, INC.)", "plan_name": "ALLY-ALIGN (FKA SPARTAN PLAN NJ, INC.)", "methodology": "fee schedule", "standard_charge_dollar": 8.26, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Americhoice (UHC)", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 7.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Amerihealth", "plan_name": "Amerihealth Medicare", "methodology": "fee schedule", "standard_charge_dollar": 7.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 11.41, "additional_payer_notes": "Laboratory - 145.00% of Medicare Rates" }, { "payer_name": "Clover Health", "plan_name": "Clover Medicare", "methodology": "fee schedule", "standard_charge_dollar": 7.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Coventry", "plan_name": "Coventry Auto", "methodology": "fee schedule", "standard_charge_dollar": 15.74, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Coventry", "plan_name": "Coventry Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 15.74, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "fee schedule", "standard_charge_dollar": 11.02, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Fairprice Healthcare Holdings", "plan_name": "Fairprice Healthcare Holdings", "methodology": "fee schedule", "standard_charge_dollar": 9.44, "additional_payer_notes": "Laboratory - 120.00% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ HMO POS", "methodology": "fee schedule", "standard_charge_dollar": 22.59, "additional_payer_notes": "177.30% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ Indemnity", "methodology": "fee schedule", "standard_charge_dollar": 22.59, "additional_payer_notes": "177.30% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ PPO", "methodology": "fee schedule", "standard_charge_dollar": 22.59, "additional_payer_notes": "177.30% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon Medicare", "methodology": "fee schedule", "standard_charge_dollar": 7.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Military Tricare", "methodology": "fee schedule", "standard_charge_dollar": 6.3, "additional_payer_notes": "80.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 7.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 7.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC All Payer (02-01-2023 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 4.72 }, { "payer_name": "UHC", "plan_name": "UHC Medicaid (02/01/2023 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 6.3 }, { "payer_name": "UHC", "plan_name": "UHC Oxford (02-01-2023 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 4.72 }, { "payer_name": "UHC - Adhoc", "plan_name": "UHC - Adhoc All Payer", "methodology": "fee schedule", "standard_charge_dollar": 7.87 }, { "payer_name": "UHC - Adhoc", "plan_name": "UHC - Adhoc Oxford", "methodology": "fee schedule", "standard_charge_dollar": 7.87 }, { "payer_name": "Wellcare", "plan_name": "Wellcare Insurance Exchange", "methodology": "fee schedule", "standard_charge_dollar": 10.62, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 7.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup Medicare", "methodology": "fee schedule", "standard_charge_dollar": 7.87, "additional_payer_notes": "100.00% of Medicare Rates" } ] } ] }, { "description": "Hc Perq Mechan Thrombectomy Venous", "code_information": [ { "code": "37187", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 45163.0, "discounted_cash": 13647.0, "minimum": 2472.0, "maximum": 36130.4, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 28932.91, "additional_payer_notes": "212.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medical Rental Network", "methodology": "fee schedule", "standard_charge_dollar": 28932.91, "additional_payer_notes": "212.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 13647.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "ALLY-ALIGN (FKA SPARTAN PLAN NJ, INC.)", "plan_name": "ALLY-ALIGN (FKA SPARTAN PLAN NJ, INC.)", "methodology": "fee schedule", "standard_charge_dollar": 14329.98, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Americhoice (UHC)", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 13647.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Amerihealth", "plan_name": "Amerihealth Medicare", "methodology": "fee schedule", "standard_charge_dollar": 13647.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 20055.15, "additional_payer_notes": "146.95% of Medicare Rates" }, { "payer_name": "Clover Health", "plan_name": "Clover Medicare", "methodology": "fee schedule", "standard_charge_dollar": 13647.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Coventry", "plan_name": "Coventry Auto", "methodology": "fee schedule", "standard_charge_dollar": 27295.2, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Coventry", "plan_name": "Coventry Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 27295.2, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "fee schedule", "standard_charge_dollar": 19106.64, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Fairprice Healthcare Holdings", "plan_name": "Fairprice Healthcare Holdings", "methodology": "fee schedule", "standard_charge_dollar": 21836.16, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ HMO POS", "methodology": "fee schedule", "standard_charge_dollar": 24197.19, "additional_payer_notes": "177.30% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ Indemnity", "methodology": "fee schedule", "standard_charge_dollar": 24197.19, "additional_payer_notes": "177.30% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ PPO", "methodology": "fee schedule", "standard_charge_dollar": 24197.19, "additional_payer_notes": "177.30% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon Medicare", "methodology": "fee schedule", "standard_charge_dollar": 13647.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Military Tricare", "methodology": "fee schedule", "standard_charge_dollar": 10918.08, "additional_payer_notes": "80.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 13647.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 13647.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC All Payer (02-01-2023 to 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 6624.0 }, { "payer_name": "UHC", "plan_name": "UHC Oxford (02-01-2023 to 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 6317.0 }, { "payer_name": "UHC - Adhoc", "plan_name": "UHC - Adhoc All Payer", "methodology": "case rate", "standard_charge_dollar": 7031.0 }, { "payer_name": "UHC - Adhoc", "plan_name": "UHC - Adhoc Oxford", "methodology": "case rate", "standard_charge_dollar": 6510.0 }, { "payer_name": "Wellcare", "plan_name": "Wellcare Insurance Exchange", "methodology": "fee schedule", "standard_charge_dollar": 18424.26, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 13647.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellchoice", "plan_name": "WELLCHOICE HMO of NJ (Empire) Commercial (HMO / HMO POS, PPO)", "methodology": "case rate", "standard_charge_dollar": 2472.0 }, { "payer_name": "Wellchoice", "plan_name": "WELLCHOICE HMO of NJ (Empire) Commercial (Indemnity)", "methodology": "case rate", "standard_charge_dollar": 2753.0 }, { "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup Medicare", "methodology": "fee schedule", "standard_charge_dollar": 13647.6, "additional_payer_notes": "100.00% of Medicare Rates" } ] } ] }, { "description": "MISCELLANEOUS DISORDERS OF NUTRITION, METABOLISM, FLUIDS AND ELECTROLYTES WITHOUT MCC", "code_information": [ { "code": "641", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 10549.0, "minimum": 4695.11, "maximum": 19095.4276, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "case rate", "standard_charge_dollar": 19095.43, "additional_payer_notes": "181.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medical Rental Network", "methodology": "case rate", "standard_charge_dollar": 19095.43, "additional_payer_notes": "181.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "case rate", "standard_charge_dollar": 8778.05, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "ALLY-ALIGN (FKA SPARTAN PLAN NJ, INC.)", "plan_name": "ALLY-ALIGN (FKA SPARTAN PLAN NJ, INC.)", "methodology": "case rate", "standard_charge_dollar": 11077.46, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Americhoice (UHC)", "plan_name": "UHC Medicare", "methodology": "case rate", "standard_charge_dollar": 8778.05, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Amerihealth", "plan_name": "Amerihealth Medicare", "methodology": "case rate", "standard_charge_dollar": 8778.05, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Commercial", "methodology": "case rate", "standard_charge_dollar": 11385.07 }, { "payer_name": "Clover Health", "plan_name": "Clover Medicare", "methodology": "case rate", "standard_charge_dollar": 8778.05, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Coventry", "plan_name": "Coventry Auto", "methodology": "case rate", "standard_charge_dollar": 17934.93, "additional_payer_notes": "170.00% of Medicare Rates" }, { "payer_name": "Coventry", "plan_name": "Coventry Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 17934.93, "additional_payer_notes": "170.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "case rate", "standard_charge_dollar": 13714.95, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Fairprice Healthcare Holdings", "plan_name": "Fairprice Healthcare Holdings", "methodology": "case rate", "standard_charge_dollar": 16879.94, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon Medicare", "methodology": "case rate", "standard_charge_dollar": 8778.05, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon NJ Health Medicaid", "methodology": "case rate", "standard_charge_dollar": 4695.11 }, { "payer_name": "Humana", "plan_name": "Humana Military Tricare", "methodology": "case rate", "standard_charge_dollar": 8439.97, "additional_payer_notes": "80.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 10549.96, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 8211.61 }, { "payer_name": "UBH", "plan_name": "UBH Medicare", "methodology": "case rate", "standard_charge_dollar": 8778.05, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC All Payer (02-01-2023 to 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 13117.34 }, { "payer_name": "UHC", "plan_name": "UHC Oxford (02-01-2023 to 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 11431.76 }, { "payer_name": "UHC - Adhoc", "plan_name": "UHC - Adhoc All Payer", "methodology": "case rate", "standard_charge_dollar": 13924.33 }, { "payer_name": "UHC - Adhoc", "plan_name": "UHC - Adhoc Oxford", "methodology": "case rate", "standard_charge_dollar": 11780.39 }, { "payer_name": "Wellcare", "plan_name": "Wellcare Insurance Exchange", "methodology": "case rate", "standard_charge_dollar": 14242.45, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "case rate", "standard_charge_dollar": 8778.05, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup Medicare", "methodology": "case rate", "standard_charge_dollar": 8778.05, "additional_payer_notes": "100.00% of Medicare Rates" } ] } ] }, { "description": "ANGINA PECTORIS & CORONARY ATHEROSCLEROSIS - SOI : 3", "code_information": [ { "code": "1983", "type": "APR-DRG" } ], "standard_charges": [ { "setting": "inpatient", "minimum": 9225.6, "maximum": 10148.16, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Better Health - Medi Medi", "methodology": "case rate", "standard_charge_dollar": 10148.16, "additional_payer_notes": "110% of State Medicaid Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Better Health Medicaid", "methodology": "case rate", "standard_charge_dollar": 10148.16, "additional_payer_notes": "110% of State Medicaid Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "case rate", "standard_charge_dollar": 9225.6, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "UBH", "plan_name": "UBH Medicaid", "methodology": "case rate", "standard_charge_dollar": 9225.6, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicaid (02/01/2023 to 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 9410.11, "additional_payer_notes": "102% of State Medicaid Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicaid", "methodology": "case rate", "standard_charge_dollar": 9225.6, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup Medicaid", "methodology": "case rate", "standard_charge_dollar": 9225.6, "additional_payer_notes": "100% of State Medicaid Rates" } ] } ] }, { "description": "Hc Ablation & Reconstruction Atria Limited", "code_information": [ { "code": "33254", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 1047.77, "minimum": 200.0193, "maximum": 1047.77, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1047.77, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC All Payer (02-01-2023 to 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 1047.77 }, { "payer_name": "UHC", "plan_name": "UHC Oxford (02-01-2023 to 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 1047.77 }, { "payer_name": "UHC - Adhoc", "plan_name": "UHC - Adhoc All Payer", "methodology": "case rate", "standard_charge_dollar": 1047.77 }, { "payer_name": "UHC - Adhoc", "plan_name": "UHC - Adhoc Oxford", "methodology": "case rate", "standard_charge_dollar": 1047.77 }, { "payer_name": "Wellchoice", "plan_name": "WELLCHOICE HMO of NJ (Empire) Commercial (HMO / HMO POS, PPO)", "methodology": "case rate", "standard_charge_dollar": 1047.77 }, { "payer_name": "Wellchoice", "plan_name": "WELLCHOICE HMO of NJ (Empire) Commercial (Indemnity)", "methodology": "case rate", "standard_charge_dollar": 1047.77 } ] } ] }, { "description": "Hc Slctv Cath Intrcrnl Brnch Angio Intrl Carot/Vert", "code_information": [ { "code": "36228", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 9336.5, "minimum": 1782.3378, "maximum": 7469.2, "payers_information": [ { "payer_name": "UHC", "plan_name": "UHC All Payer (02-01-2023 to 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 3057.0 }, { "payer_name": "UHC", "plan_name": "UHC Oxford (02-01-2023 to 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 2297.0 }, { "payer_name": "UHC - Adhoc", "plan_name": "UHC - Adhoc All Payer", "methodology": "case rate", "standard_charge_dollar": 3245.0 }, { "payer_name": "UHC - Adhoc", "plan_name": "UHC - Adhoc Oxford", "methodology": "case rate", "standard_charge_dollar": 2367.0 }, { "payer_name": "Wellchoice", "plan_name": "WELLCHOICE HMO of NJ (Empire) Commercial (HMO / HMO POS, PPO)", "methodology": "case rate", "standard_charge_dollar": 2472.0 }, { "payer_name": "Wellchoice", "plan_name": "WELLCHOICE HMO of NJ (Empire) Commercial (Indemnity)", "methodology": "case rate", "standard_charge_dollar": 2753.0 } ] } ] }, { "description": "Hc Catheter Aspiratn Nasotrach", "code_information": [ { "code": "31720", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 875.61, "discounted_cash": 258.0, "minimum": 167.1539, "maximum": 875.61, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 548.83, "additional_payer_notes": "212.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medical Rental Network", "methodology": "fee schedule", "standard_charge_dollar": 548.83, "additional_payer_notes": "212.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 258.88, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "ALLY-ALIGN (FKA SPARTAN PLAN NJ, INC.)", "plan_name": "ALLY-ALIGN (FKA SPARTAN PLAN NJ, INC.)", "methodology": "fee schedule", "standard_charge_dollar": 271.82, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Americhoice (UHC)", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 258.88, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Amerihealth", "plan_name": "Amerihealth Medicare", "methodology": "fee schedule", "standard_charge_dollar": 258.88, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 380.42, "additional_payer_notes": "146.95% of Medicare Rates" }, { "payer_name": "Clover Health", "plan_name": "Clover Medicare", "methodology": "fee schedule", "standard_charge_dollar": 258.88, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Coventry", "plan_name": "Coventry Auto", "methodology": "fee schedule", "standard_charge_dollar": 517.76, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Coventry", "plan_name": "Coventry Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 517.76, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "fee schedule", "standard_charge_dollar": 362.43, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Fairprice Healthcare Holdings", "plan_name": "Fairprice Healthcare Holdings", "methodology": "fee schedule", "standard_charge_dollar": 414.21, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ HMO POS", "methodology": "fee schedule", "standard_charge_dollar": 458.99, "additional_payer_notes": "177.30% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ Indemnity", "methodology": "fee schedule", "standard_charge_dollar": 458.99, "additional_payer_notes": "177.30% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ PPO", "methodology": "fee schedule", "standard_charge_dollar": 458.99, "additional_payer_notes": "177.30% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon Medicare", "methodology": "fee schedule", "standard_charge_dollar": 258.88, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Military Tricare", "methodology": "fee schedule", "standard_charge_dollar": 207.1, "additional_payer_notes": "80.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 258.88, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 258.88, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC All Payer (02-01-2023 to 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 875.61 }, { "payer_name": "UHC", "plan_name": "UHC Oxford (02-01-2023 to 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 875.61 }, { "payer_name": "UHC - Adhoc", "plan_name": "UHC - Adhoc All Payer", "methodology": "case rate", "standard_charge_dollar": 875.61 }, { "payer_name": "UHC - Adhoc", "plan_name": "UHC - Adhoc Oxford", "methodology": "case rate", "standard_charge_dollar": 875.61 }, { "payer_name": "Wellcare", "plan_name": "Wellcare Insurance Exchange", "methodology": "fee schedule", "standard_charge_dollar": 349.49, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 258.88, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellchoice", "plan_name": "WELLCHOICE HMO of NJ (Empire) Commercial (HMO / HMO POS, PPO)", "methodology": "case rate", "standard_charge_dollar": 875.61 }, { "payer_name": "Wellchoice", "plan_name": "WELLCHOICE HMO of NJ (Empire) Commercial (Indemnity)", "methodology": "case rate", "standard_charge_dollar": 875.61 }, { "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup Medicare", "methodology": "fee schedule", "standard_charge_dollar": 258.88, "additional_payer_notes": "100.00% of Medicare Rates" } ] } ] }, { "description": "EXTENSIVE O.R. PROCEDURE UNRELATED TO PRINCIPAL DIAGNOSIS- SOI : 4", "code_information": [ { "code": "9504", "type": "APR-DRG" } ], "standard_charges": [ { "setting": "inpatient", "minimum": 68259.32, "maximum": 75085.25, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Better Health - Medi Medi", "methodology": "case rate", "standard_charge_dollar": 75085.25, "additional_payer_notes": "110% of State Medicaid Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Better Health Medicaid", "methodology": "case rate", "standard_charge_dollar": 75085.25, "additional_payer_notes": "110% of State Medicaid Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "case rate", "standard_charge_dollar": 68259.32, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "UBH", "plan_name": "UBH Medicaid", "methodology": "case rate", "standard_charge_dollar": 68259.32, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicaid (02/01/2023 to 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 69624.51, "additional_payer_notes": "102% of State Medicaid Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicaid", "methodology": "case rate", "standard_charge_dollar": 68259.32, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup Medicaid", "methodology": "case rate", "standard_charge_dollar": 68259.32, "additional_payer_notes": "100% of State Medicaid Rates" } ] } ] }, { "description": "TENDON, MUSCLE & OTHER SOFT TISSUE PROCEDURES - SOI : 1", "code_information": [ { "code": "3171", "type": "APR-DRG" } ], "standard_charges": [ { "setting": "inpatient", "minimum": 12131.06, "maximum": 13344.17, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Better Health - Medi Medi", "methodology": "case rate", "standard_charge_dollar": 13344.17, "additional_payer_notes": "110% of State Medicaid Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Better Health Medicaid", "methodology": "case rate", "standard_charge_dollar": 13344.17, "additional_payer_notes": "110% of State Medicaid Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "case rate", "standard_charge_dollar": 12131.06, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "UBH", "plan_name": "UBH Medicaid", "methodology": "case rate", "standard_charge_dollar": 12131.06, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicaid (02/01/2023 to 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 12373.68, "additional_payer_notes": "102% of State Medicaid Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicaid", "methodology": "case rate", "standard_charge_dollar": 12131.06, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup Medicaid", "methodology": "case rate", "standard_charge_dollar": 12131.06, "additional_payer_notes": "100% of State Medicaid Rates" } ] } ] }, { "description": "HEART TRANSPLANT OR IMPLANT OF HEART ASSIST SYSTEM WITH MCC", "code_information": [ { "code": "001", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 325414.0, "minimum": 164916.61, "maximum": 588999.4848, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "case rate", "standard_charge_dollar": 261605.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "ALLY-ALIGN (FKA SPARTAN PLAN NJ, INC.)", "plan_name": "ALLY-ALIGN (FKA SPARTAN PLAN NJ, INC.)", "methodology": "case rate", "standard_charge_dollar": 341684.78, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Americhoice (UHC)", "plan_name": "UHC Medicare", "methodology": "case rate", "standard_charge_dollar": 261605.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Amerihealth", "plan_name": "Amerihealth Medicare", "methodology": "case rate", "standard_charge_dollar": 261605.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Commercial", "methodology": "case rate", "standard_charge_dollar": 409989.66 }, { "payer_name": "Clover Health", "plan_name": "Clover Medicare", "methodology": "case rate", "standard_charge_dollar": 261605.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Coventry", "plan_name": "Coventry Auto", "methodology": "case rate", "standard_charge_dollar": 553203.94, "additional_payer_notes": "170.00% of Medicare Rates" }, { "payer_name": "Coventry", "plan_name": "Coventry Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 553203.94, "additional_payer_notes": "170.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "case rate", "standard_charge_dollar": 423038.3, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Fairprice Healthcare Holdings", "plan_name": "Fairprice Healthcare Holdings", "methodology": "case rate", "standard_charge_dollar": 520662.53, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon Medicare", "methodology": "case rate", "standard_charge_dollar": 261605.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon NJ Health Medicaid", "methodology": "case rate", "standard_charge_dollar": 164916.61 }, { "payer_name": "Humana", "plan_name": "Humana Military Tricare", "methodology": "case rate", "standard_charge_dollar": 260331.26, "additional_payer_notes": "80.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 325414.08, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 503773.0 }, { "payer_name": "UBH", "plan_name": "UBH Medicare", "methodology": "case rate", "standard_charge_dollar": 261605.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC All Payer (02-01-2023 to 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 472370.86 }, { "payer_name": "UHC", "plan_name": "UHC Oxford (02-01-2023 to 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 411671.09 }, { "payer_name": "UHC - Adhoc", "plan_name": "UHC - Adhoc All Payer", "methodology": "case rate", "standard_charge_dollar": 501431.64 }, { "payer_name": "UHC - Adhoc", "plan_name": "UHC - Adhoc Oxford", "methodology": "case rate", "standard_charge_dollar": 424225.8 }, { "payer_name": "Wellcare", "plan_name": "Wellcare Insurance Exchange", "methodology": "case rate", "standard_charge_dollar": 439309.01, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "case rate", "standard_charge_dollar": 261605.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup Medicare", "methodology": "case rate", "standard_charge_dollar": 261605.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "case rate", "standard_charge_dollar": 588999.48, "additional_payer_notes": "181.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medical Rental Network", "methodology": "case rate", "standard_charge_dollar": 588999.48, "additional_payer_notes": "181.00% of Medicare Rates" } ] } ] }, { "description": "Ligation/Bx Temporal Artery", "code_information": [ { "code": "37609", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 18752.5, "discounted_cash": 1952.0, "minimum": 1562.024, "maximum": 15002.0, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 4139.36, "additional_payer_notes": "212.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medical Rental Network", "methodology": "fee schedule", "standard_charge_dollar": 4139.36, "additional_payer_notes": "212.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1952.53, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "ALLY-ALIGN (FKA SPARTAN PLAN NJ, INC.)", "plan_name": "ALLY-ALIGN (FKA SPARTAN PLAN NJ, INC.)", "methodology": "fee schedule", "standard_charge_dollar": 2050.16, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Americhoice (UHC)", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1952.53, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Amerihealth", "plan_name": "Amerihealth Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1952.53, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 2869.24, "additional_payer_notes": "146.95% of Medicare Rates" }, { "payer_name": "Clover Health", "plan_name": "Clover Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1952.53, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Coventry", "plan_name": "Coventry Auto", "methodology": "fee schedule", "standard_charge_dollar": 3905.06, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Coventry", "plan_name": "Coventry Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 3905.06, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "fee schedule", "standard_charge_dollar": 2733.54, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Fairprice Healthcare Holdings", "plan_name": "Fairprice Healthcare Holdings", "methodology": "fee schedule", "standard_charge_dollar": 3124.05, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ HMO POS", "methodology": "fee schedule", "standard_charge_dollar": 3461.84, "additional_payer_notes": "177.30% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ Indemnity", "methodology": "fee schedule", "standard_charge_dollar": 3461.84, "additional_payer_notes": "177.30% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ PPO", "methodology": "fee schedule", "standard_charge_dollar": 3461.84, "additional_payer_notes": "177.30% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1952.53, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Military Tricare", "methodology": "fee schedule", "standard_charge_dollar": 1562.02, "additional_payer_notes": "80.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1952.53, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 1952.53, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC All Payer (02-01-2023 to 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 3912.0 }, { "payer_name": "UHC", "plan_name": "UHC Oxford (02-01-2023 to 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 3676.0 }, { "payer_name": "UHC - Adhoc", "plan_name": "UHC - Adhoc All Payer", "methodology": "case rate", "standard_charge_dollar": 4153.0 }, { "payer_name": "UHC - Adhoc", "plan_name": "UHC - Adhoc Oxford", "methodology": "case rate", "standard_charge_dollar": 3788.0 }, { "payer_name": "Wellcare", "plan_name": "Wellcare Insurance Exchange", "methodology": "fee schedule", "standard_charge_dollar": 2635.92, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1952.53, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellchoice", "plan_name": "WELLCHOICE HMO of NJ (Empire) Commercial (HMO / HMO POS, PPO)", "methodology": "case rate", "standard_charge_dollar": 1715.0 }, { "payer_name": "Wellchoice", "plan_name": "WELLCHOICE HMO of NJ (Empire) Commercial (Indemnity)", "methodology": "case rate", "standard_charge_dollar": 1978.0 }, { "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1952.53, "additional_payer_notes": "100.00% of Medicare Rates" } ] } ] }, { "description": "Hc West Nile Virus Ab, Igm", "code_information": [ { "code": "86788", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 95.0, "discounted_cash": 16.0, "minimum": 10.11, "maximum": 80.75, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 35.72, "additional_payer_notes": "212.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medical Rental Network", "methodology": "fee schedule", "standard_charge_dollar": 35.72, "additional_payer_notes": "212.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 16.85, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "ALLY-ALIGN (FKA SPARTAN PLAN NJ, INC.)", "plan_name": "ALLY-ALIGN (FKA SPARTAN PLAN NJ, INC.)", "methodology": "fee schedule", "standard_charge_dollar": 17.69, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Americhoice (UHC)", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 16.85, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Amerihealth", "plan_name": "Amerihealth Medicare", "methodology": "fee schedule", "standard_charge_dollar": 16.85, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 24.43, "additional_payer_notes": "Laboratory - 145.00% of Medicare Rates" }, { "payer_name": "Clover Health", "plan_name": "Clover Medicare", "methodology": "fee schedule", "standard_charge_dollar": 16.85, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Coventry", "plan_name": "Coventry Auto", "methodology": "fee schedule", "standard_charge_dollar": 33.7, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Coventry", "plan_name": "Coventry Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 33.7, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "fee schedule", "standard_charge_dollar": 23.59, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Fairprice Healthcare Holdings", "plan_name": "Fairprice Healthcare Holdings", "methodology": "fee schedule", "standard_charge_dollar": 20.22, "additional_payer_notes": "Laboratory - 120.00% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ HMO POS", "methodology": "fee schedule", "standard_charge_dollar": 67.07, "additional_payer_notes": "177.30% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ Indemnity", "methodology": "fee schedule", "standard_charge_dollar": 67.07, "additional_payer_notes": "177.30% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ PPO", "methodology": "fee schedule", "standard_charge_dollar": 67.07, "additional_payer_notes": "177.30% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon Medicare", "methodology": "fee schedule", "standard_charge_dollar": 16.85, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Military Tricare", "methodology": "fee schedule", "standard_charge_dollar": 13.48, "additional_payer_notes": "80.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 16.85, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 16.85, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC All Payer (02-01-2023 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 10.11 }, { "payer_name": "UHC", "plan_name": "UHC Medicaid (02/01/2023 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 13.48 }, { "payer_name": "UHC", "plan_name": "UHC Oxford (02-01-2023 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 10.11 }, { "payer_name": "UHC - Adhoc", "plan_name": "UHC - Adhoc All Payer", "methodology": "fee schedule", "standard_charge_dollar": 16.85 }, { "payer_name": "UHC - Adhoc", "plan_name": "UHC - Adhoc Oxford", "methodology": "fee schedule", "standard_charge_dollar": 16.85 }, { "payer_name": "Wellcare", "plan_name": "Wellcare Insurance Exchange", "methodology": "fee schedule", "standard_charge_dollar": 22.75, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 16.85, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup Medicare", "methodology": "fee schedule", "standard_charge_dollar": 16.85, "additional_payer_notes": "100.00% of Medicare Rates" } ] } ] }, { "description": "MAJOR HIP AND KNEE JOINT REPLACEMENT OR REATTACHMENT OF LOWER EXTREMITY WITH MCC OR TOTAL ANKLE REPLACEMENT", "code_information": [ { "code": "469", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 36609.0, "minimum": 19820.77, "maximum": 66263.738, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "case rate", "standard_charge_dollar": 66263.74, "additional_payer_notes": "181.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medical Rental Network", "methodology": "case rate", "standard_charge_dollar": 66263.74, "additional_payer_notes": "181.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "case rate", "standard_charge_dollar": 29703.4, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "ALLY-ALIGN (FKA SPARTAN PLAN NJ, INC.)", "plan_name": "ALLY-ALIGN (FKA SPARTAN PLAN NJ, INC.)", "methodology": "case rate", "standard_charge_dollar": 38440.29, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Americhoice (UHC)", "plan_name": "UHC Medicare", "methodology": "case rate", "standard_charge_dollar": 29703.4, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Amerihealth", "plan_name": "Amerihealth Medicare", "methodology": "case rate", "standard_charge_dollar": 29703.4, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Commercial", "methodology": "case rate", "standard_charge_dollar": 44375.72 }, { "payer_name": "Clover Health", "plan_name": "Clover Medicare", "methodology": "case rate", "standard_charge_dollar": 29703.4, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Coventry", "plan_name": "Coventry Auto", "methodology": "case rate", "standard_charge_dollar": 62236.66, "additional_payer_notes": "170.00% of Medicare Rates" }, { "payer_name": "Coventry", "plan_name": "Coventry Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 62236.66, "additional_payer_notes": "170.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "case rate", "standard_charge_dollar": 47592.74, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Fairprice Healthcare Holdings", "plan_name": "Fairprice Healthcare Holdings", "methodology": "case rate", "standard_charge_dollar": 58575.68, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon Medicare", "methodology": "case rate", "standard_charge_dollar": 29703.4, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon NJ Health Medicaid", "methodology": "case rate", "standard_charge_dollar": 19820.77 }, { "payer_name": "Humana", "plan_name": "Humana Military Tricare", "methodology": "case rate", "standard_charge_dollar": 29287.84, "additional_payer_notes": "80.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 36609.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 44585.1 }, { "payer_name": "UBH", "plan_name": "UBH Medicare", "methodology": "case rate", "standard_charge_dollar": 29703.4, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC All Payer (02-01-2023 to 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 51127.62 }, { "payer_name": "UHC", "plan_name": "UHC Oxford (02-01-2023 to 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 44557.71 }, { "payer_name": "UHC - Adhoc", "plan_name": "UHC - Adhoc All Payer", "methodology": "case rate", "standard_charge_dollar": 54273.05 }, { "payer_name": "UHC - Adhoc", "plan_name": "UHC - Adhoc Oxford", "methodology": "case rate", "standard_charge_dollar": 45916.58 }, { "payer_name": "Wellcare", "plan_name": "Wellcare Insurance Exchange", "methodology": "case rate", "standard_charge_dollar": 49423.23, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "case rate", "standard_charge_dollar": 29703.4, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup Medicare", "methodology": "case rate", "standard_charge_dollar": 29703.4, "additional_payer_notes": "100.00% of Medicare Rates" } ] } ] }, { "description": "CHEST PAIN - SOI : 3", "code_information": [ { "code": "2033", "type": "APR-DRG" } ], "standard_charges": [ { "setting": "inpatient", "minimum": 8929.13, "maximum": 9822.05, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Better Health - Medi Medi", "methodology": "case rate", "standard_charge_dollar": 9822.05, "additional_payer_notes": "110% of State Medicaid Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Better Health Medicaid", "methodology": "case rate", "standard_charge_dollar": 9822.05, "additional_payer_notes": "110% of State Medicaid Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "case rate", "standard_charge_dollar": 8929.13, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "UBH", "plan_name": "UBH Medicaid", "methodology": "case rate", "standard_charge_dollar": 8929.13, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicaid (02/01/2023 to 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 9107.72, "additional_payer_notes": "102% of State Medicaid Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicaid", "methodology": "case rate", "standard_charge_dollar": 8929.13, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup Medicaid", "methodology": "case rate", "standard_charge_dollar": 8929.13, "additional_payer_notes": "100% of State Medicaid Rates" } ] } ] }, { "description": "Hc Debridement Open Wound 20 Sq Cm<", "code_information": [ { "code": "97597", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 988.0, "discounted_cash": 237.0, "minimum": 188.6092, "maximum": 988.0, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 502.82, "additional_payer_notes": "212.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medical Rental Network", "methodology": "fee schedule", "standard_charge_dollar": 502.82, "additional_payer_notes": "212.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 237.18, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "ALLY-ALIGN (FKA SPARTAN PLAN NJ, INC.)", "plan_name": "ALLY-ALIGN (FKA SPARTAN PLAN NJ, INC.)", "methodology": "fee schedule", "standard_charge_dollar": 249.04, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Americhoice (UHC)", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 237.18, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Amerihealth", "plan_name": "Amerihealth Medicare", "methodology": "fee schedule", "standard_charge_dollar": 237.18, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 348.54, "additional_payer_notes": "146.95% of Medicare Rates" }, { "payer_name": "Clover Health", "plan_name": "Clover Medicare", "methodology": "fee schedule", "standard_charge_dollar": 237.18, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Coventry", "plan_name": "Coventry Auto", "methodology": "fee schedule", "standard_charge_dollar": 474.36, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Coventry", "plan_name": "Coventry Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 474.36, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "fee schedule", "standard_charge_dollar": 332.05, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Fairprice Healthcare Holdings", "plan_name": "Fairprice Healthcare Holdings", "methodology": "fee schedule", "standard_charge_dollar": 379.49, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ HMO POS", "methodology": "fee schedule", "standard_charge_dollar": 420.52, "additional_payer_notes": "177.30% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ Indemnity", "methodology": "fee schedule", "standard_charge_dollar": 420.52, "additional_payer_notes": "177.30% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ PPO", "methodology": "fee schedule", "standard_charge_dollar": 420.52, "additional_payer_notes": "177.30% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon Medicare", "methodology": "fee schedule", "standard_charge_dollar": 237.18, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Military Tricare", "methodology": "fee schedule", "standard_charge_dollar": 189.74, "additional_payer_notes": "80.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 237.18, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 237.18, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC All Payer (02-01-2023 to 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 988.0 }, { "payer_name": "UHC", "plan_name": "UHC Oxford (02-01-2023 to 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 988.0 }, { "payer_name": "UHC - Adhoc", "plan_name": "UHC - Adhoc All Payer", "methodology": "case rate", "standard_charge_dollar": 988.0 }, { "payer_name": "UHC - Adhoc", "plan_name": "UHC - Adhoc Oxford", "methodology": "case rate", "standard_charge_dollar": 988.0 }, { "payer_name": "Wellcare", "plan_name": "Wellcare Insurance Exchange", "methodology": "fee schedule", "standard_charge_dollar": 320.19, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 237.18, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellchoice", "plan_name": "WELLCHOICE HMO of NJ (Empire) Commercial (HMO / HMO POS, PPO)", "methodology": "case rate", "standard_charge_dollar": 988.0 }, { "payer_name": "Wellchoice", "plan_name": "WELLCHOICE HMO of NJ (Empire) Commercial (Indemnity)", "methodology": "case rate", "standard_charge_dollar": 988.0 }, { "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup Medicare", "methodology": "fee schedule", "standard_charge_dollar": 237.18, "additional_payer_notes": "100.00% of Medicare Rates" } ] } ] }, { "description": "LAPAROSCOPY SURG COLPOPEXY", "code_information": [ { "code": "57425", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 25882.97, "discounted_cash": 12566.0, "minimum": 1715.0, "maximum": 25882.97, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 25882.97, "additional_payer_notes": "212.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medical Rental Network", "methodology": "fee schedule", "standard_charge_dollar": 25882.97, "additional_payer_notes": "212.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 12566.64, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "ALLY-ALIGN (FKA SPARTAN PLAN NJ, INC.)", "plan_name": "ALLY-ALIGN (FKA SPARTAN PLAN NJ, INC.)", "methodology": "fee schedule", "standard_charge_dollar": 13194.97, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Americhoice (UHC)", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 12566.64, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Amerihealth", "plan_name": "Amerihealth Medicare", "methodology": "fee schedule", "standard_charge_dollar": 12566.64, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 18466.68, "additional_payer_notes": "146.95% of Medicare Rates" }, { "payer_name": "Clover Health", "plan_name": "Clover Medicare", "methodology": "fee schedule", "standard_charge_dollar": 12566.64, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Coventry", "plan_name": "Coventry Auto", "methodology": "fee schedule", "standard_charge_dollar": 25133.28, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Coventry", "plan_name": "Coventry Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 25133.28, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "fee schedule", "standard_charge_dollar": 17593.3, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Fairprice Healthcare Holdings", "plan_name": "Fairprice Healthcare Holdings", "methodology": "fee schedule", "standard_charge_dollar": 20106.62, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ HMO POS", "methodology": "fee schedule", "standard_charge_dollar": 22280.65, "additional_payer_notes": "177.30% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ Indemnity", "methodology": "fee schedule", "standard_charge_dollar": 22280.65, "additional_payer_notes": "177.30% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ PPO", "methodology": "fee schedule", "standard_charge_dollar": 22280.65, "additional_payer_notes": "177.30% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon Medicare", "methodology": "fee schedule", "standard_charge_dollar": 12566.64, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Military Tricare", "methodology": "fee schedule", "standard_charge_dollar": 10053.31, "additional_payer_notes": "80.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 12566.64, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 12566.64, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC All Payer (02-01-2023 to 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 6624.0 }, { "payer_name": "UHC", "plan_name": "UHC Oxford (02-01-2023 to 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 6317.0 }, { "payer_name": "UHC - Adhoc", "plan_name": "UHC - Adhoc All Payer", "methodology": "case rate", "standard_charge_dollar": 7031.0 }, { "payer_name": "UHC - Adhoc", "plan_name": "UHC - Adhoc Oxford", "methodology": "case rate", "standard_charge_dollar": 6510.0 }, { "payer_name": "Wellcare", "plan_name": "Wellcare Insurance Exchange", "methodology": "fee schedule", "standard_charge_dollar": 16964.96, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 12566.64, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellchoice", "plan_name": "WELLCHOICE HMO of NJ (Empire) Commercial (HMO / HMO POS, PPO)", "methodology": "case rate", "standard_charge_dollar": 1715.0 }, { "payer_name": "Wellchoice", "plan_name": "WELLCHOICE HMO of NJ (Empire) Commercial (Indemnity)", "methodology": "case rate", "standard_charge_dollar": 1978.0 }, { "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup Medicare", "methodology": "fee schedule", "standard_charge_dollar": 12566.64, "additional_payer_notes": "100.00% of Medicare Rates" } ] } ] }, { "description": "Removal Of Hemorrhoid Clot", "code_information": [ { "code": "46320", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 25965.0, "discounted_cash": 1414.0, "minimum": 697.184, "maximum": 20772.0, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 2999.1, "additional_payer_notes": "212.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medical Rental Network", "methodology": "fee schedule", "standard_charge_dollar": 2999.1, "additional_payer_notes": "212.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1414.67, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "ALLY-ALIGN (FKA SPARTAN PLAN NJ, INC.)", "plan_name": "ALLY-ALIGN (FKA SPARTAN PLAN NJ, INC.)", "methodology": "fee schedule", "standard_charge_dollar": 1485.4, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Americhoice (UHC)", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1414.67, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Amerihealth", "plan_name": "Amerihealth Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1414.67, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 2078.86, "additional_payer_notes": "146.95% of Medicare Rates" }, { "payer_name": "Clover Health", "plan_name": "Clover Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1414.67, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Coventry", "plan_name": "Coventry Auto", "methodology": "fee schedule", "standard_charge_dollar": 2829.34, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Coventry", "plan_name": "Coventry Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 2829.34, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "fee schedule", "standard_charge_dollar": 1980.54, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Fairprice Healthcare Holdings", "plan_name": "Fairprice Healthcare Holdings", "methodology": "fee schedule", "standard_charge_dollar": 2263.47, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ HMO POS", "methodology": "fee schedule", "standard_charge_dollar": 2508.21, "additional_payer_notes": "177.30% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ Indemnity", "methodology": "fee schedule", "standard_charge_dollar": 2508.21, "additional_payer_notes": "177.30% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ PPO", "methodology": "fee schedule", "standard_charge_dollar": 2508.21, "additional_payer_notes": "177.30% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1414.67, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Military Tricare", "methodology": "fee schedule", "standard_charge_dollar": 1131.74, "additional_payer_notes": "80.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1414.67, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 1414.67, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC All Payer (02-01-2023 to 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 3912.0 }, { "payer_name": "UHC", "plan_name": "UHC Oxford (02-01-2023 to 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 3676.0 }, { "payer_name": "UHC - Adhoc", "plan_name": "UHC - Adhoc All Payer", "methodology": "case rate", "standard_charge_dollar": 4153.0 }, { "payer_name": "UHC - Adhoc", "plan_name": "UHC - Adhoc Oxford", "methodology": "case rate", "standard_charge_dollar": 3788.0 }, { "payer_name": "Wellcare", "plan_name": "Wellcare Insurance Exchange", "methodology": "fee schedule", "standard_charge_dollar": 1909.8, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1414.67, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellchoice", "plan_name": "WELLCHOICE HMO of NJ (Empire) Commercial (HMO / HMO POS, PPO)", "methodology": "case rate", "standard_charge_dollar": 1715.0 }, { "payer_name": "Wellchoice", "plan_name": "WELLCHOICE HMO of NJ (Empire) Commercial (Indemnity)", "methodology": "case rate", "standard_charge_dollar": 1978.0 }, { "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1414.67, "additional_payer_notes": "100.00% of Medicare Rates" } ] } ] }, { "description": "UPPER LIMB AND TOE AMPUTATION FOR CIRCULATORY SYSTEM DISORDERS WITH CC", "code_information": [ { "code": "256", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 21178.0, "minimum": 10919.47, "maximum": 38332.9945, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "case rate", "standard_charge_dollar": 38332.99, "additional_payer_notes": "181.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medical Rental Network", "methodology": "case rate", "standard_charge_dollar": 38332.99, "additional_payer_notes": "181.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "case rate", "standard_charge_dollar": 17312.4, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "ALLY-ALIGN (FKA SPARTAN PLAN NJ, INC.)", "plan_name": "ALLY-ALIGN (FKA SPARTAN PLAN NJ, INC.)", "methodology": "case rate", "standard_charge_dollar": 22237.37, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Americhoice (UHC)", "plan_name": "UHC Medicare", "methodology": "case rate", "standard_charge_dollar": 17312.4, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Amerihealth", "plan_name": "Amerihealth Medicare", "methodology": "case rate", "standard_charge_dollar": 17312.4, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Commercial", "methodology": "case rate", "standard_charge_dollar": 24840.28 }, { "payer_name": "Clover Health", "plan_name": "Clover Medicare", "methodology": "case rate", "standard_charge_dollar": 17312.4, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Coventry", "plan_name": "Coventry Auto", "methodology": "case rate", "standard_charge_dollar": 36003.37, "additional_payer_notes": "170.00% of Medicare Rates" }, { "payer_name": "Coventry", "plan_name": "Coventry Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 36003.37, "additional_payer_notes": "170.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "case rate", "standard_charge_dollar": 27531.99, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Fairprice Healthcare Holdings", "plan_name": "Fairprice Healthcare Holdings", "methodology": "case rate", "standard_charge_dollar": 33885.52, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon Medicare", "methodology": "case rate", "standard_charge_dollar": 17312.4, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon NJ Health Medicaid", "methodology": "case rate", "standard_charge_dollar": 10919.47 }, { "payer_name": "Humana", "plan_name": "Humana Military Tricare", "methodology": "case rate", "standard_charge_dollar": 16942.76, "additional_payer_notes": "80.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 21178.45, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 24641.4 }, { "payer_name": "UBH", "plan_name": "UBH Medicare", "methodology": "case rate", "standard_charge_dollar": 17312.4, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC All Payer (02-01-2023 to 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 28619.8 }, { "payer_name": "UHC", "plan_name": "UHC Oxford (02-01-2023 to 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 24942.15 }, { "payer_name": "UHC - Adhoc", "plan_name": "UHC - Adhoc All Payer", "methodology": "case rate", "standard_charge_dollar": 30380.52 }, { "payer_name": "UHC - Adhoc", "plan_name": "UHC - Adhoc Oxford", "methodology": "case rate", "standard_charge_dollar": 25702.81 }, { "payer_name": "Wellcare", "plan_name": "Wellcare Insurance Exchange", "methodology": "case rate", "standard_charge_dollar": 28590.91, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "case rate", "standard_charge_dollar": 17312.4, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup Medicare", "methodology": "case rate", "standard_charge_dollar": 17312.4, "additional_payer_notes": "100.00% of Medicare Rates" } ] } ] }, { "description": "MAJOR CHEST PROCEDURES WITHOUT CCMCC", "code_information": [ { "code": "165", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 23678.0, "minimum": 11567.0, "maximum": 42857.3791, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "case rate", "standard_charge_dollar": 42857.38, "additional_payer_notes": "181.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medical Rental Network", "methodology": "case rate", "standard_charge_dollar": 42857.38, "additional_payer_notes": "181.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "case rate", "standard_charge_dollar": 19319.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "ALLY-ALIGN (FKA SPARTAN PLAN NJ, INC.)", "plan_name": "ALLY-ALIGN (FKA SPARTAN PLAN NJ, INC.)", "methodology": "case rate", "standard_charge_dollar": 24862.02, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Americhoice (UHC)", "plan_name": "UHC Medicare", "methodology": "case rate", "standard_charge_dollar": 19319.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Amerihealth", "plan_name": "Amerihealth Medicare", "methodology": "case rate", "standard_charge_dollar": 19319.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Commercial", "methodology": "case rate", "standard_charge_dollar": 28004.75 }, { "payer_name": "Clover Health", "plan_name": "Clover Medicare", "methodology": "case rate", "standard_charge_dollar": 19319.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Coventry", "plan_name": "Coventry Auto", "methodology": "case rate", "standard_charge_dollar": 40252.79, "additional_payer_notes": "170.00% of Medicare Rates" }, { "payer_name": "Coventry", "plan_name": "Coventry Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 40252.79, "additional_payer_notes": "170.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "case rate", "standard_charge_dollar": 30781.54, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Fairprice Healthcare Holdings", "plan_name": "Fairprice Healthcare Holdings", "methodology": "case rate", "standard_charge_dollar": 37884.98, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon Medicare", "methodology": "case rate", "standard_charge_dollar": 19319.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon NJ Health Medicaid", "methodology": "case rate", "standard_charge_dollar": 11567.0 }, { "payer_name": "Humana", "plan_name": "Humana Military Tricare", "methodology": "case rate", "standard_charge_dollar": 18942.49, "additional_payer_notes": "80.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 23678.11, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 24216.7 }, { "payer_name": "UBH", "plan_name": "UBH Medicare", "methodology": "case rate", "standard_charge_dollar": 19319.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC All Payer (02-01-2023 to 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 32265.76 }, { "payer_name": "UHC", "plan_name": "UHC Oxford (02-01-2023 to 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 28119.6 }, { "payer_name": "UHC - Adhoc", "plan_name": "UHC - Adhoc All Payer", "methodology": "case rate", "standard_charge_dollar": 34250.78 }, { "payer_name": "UHC - Adhoc", "plan_name": "UHC - Adhoc Oxford", "methodology": "case rate", "standard_charge_dollar": 28977.16 }, { "payer_name": "Wellcare", "plan_name": "Wellcare Insurance Exchange", "methodology": "case rate", "standard_charge_dollar": 31965.45, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "case rate", "standard_charge_dollar": 19319.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup Medicare", "methodology": "case rate", "standard_charge_dollar": 19319.6, "additional_payer_notes": "100.00% of Medicare Rates" } ] } ] }, { "description": "SKIN GRAFT, EXCEPT HAND, FOR MUSCULOSKELETAL & CONNECTIVE TISSUE DIAGNOSES - SOI : 3", "code_information": [ { "code": "3123", "type": "APR-DRG" } ], "standard_charges": [ { "setting": "inpatient", "minimum": 38295.79, "maximum": 42125.37, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Better Health - Medi Medi", "methodology": "case rate", "standard_charge_dollar": 42125.37, "additional_payer_notes": "110% of State Medicaid Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Better Health Medicaid", "methodology": "case rate", "standard_charge_dollar": 42125.37, "additional_payer_notes": "110% of State Medicaid Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "case rate", "standard_charge_dollar": 38295.79, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "UBH", "plan_name": "UBH Medicaid", "methodology": "case rate", "standard_charge_dollar": 38295.79, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicaid (02/01/2023 to 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 39061.7, "additional_payer_notes": "102% of State Medicaid Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicaid", "methodology": "case rate", "standard_charge_dollar": 38295.79, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup Medicaid", "methodology": "case rate", "standard_charge_dollar": 38295.79, "additional_payer_notes": "100% of State Medicaid Rates" } ] } ] }, { "description": "Hc Cabg W/Arterial Graft Two Arterial Grafts", "code_information": [ { "code": "33534", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 4100.0, "minimum": 782.69, "maximum": 4100.0, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2330.56, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC All Payer (02-01-2023 to 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 4100.0 }, { "payer_name": "UHC", "plan_name": "UHC Oxford (02-01-2023 to 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 4020.0 }, { "payer_name": "UHC - Adhoc", "plan_name": "UHC - Adhoc All Payer", "methodology": "case rate", "standard_charge_dollar": 4100.0 }, { "payer_name": "UHC - Adhoc", "plan_name": "UHC - Adhoc Oxford", "methodology": "case rate", "standard_charge_dollar": 4100.0 }, { "payer_name": "Wellchoice", "plan_name": "WELLCHOICE HMO of NJ (Empire) Commercial (HMO / HMO POS, PPO)", "methodology": "case rate", "standard_charge_dollar": 1715.0 }, { "payer_name": "Wellchoice", "plan_name": "WELLCHOICE HMO of NJ (Empire) Commercial (Indemnity)", "methodology": "case rate", "standard_charge_dollar": 1978.0 } ] } ] }, { "description": "PNEUMOTHORAX WITH MCC", "code_information": [ { "code": "199", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 21943.0, "minimum": 10960.2, "maximum": 39717.7169, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "case rate", "standard_charge_dollar": 39717.72, "additional_payer_notes": "181.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medical Rental Network", "methodology": "case rate", "standard_charge_dollar": 39717.72, "additional_payer_notes": "181.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "case rate", "standard_charge_dollar": 17926.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "ALLY-ALIGN (FKA SPARTAN PLAN NJ, INC.)", "plan_name": "ALLY-ALIGN (FKA SPARTAN PLAN NJ, INC.)", "methodology": "case rate", "standard_charge_dollar": 23040.66, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Americhoice (UHC)", "plan_name": "UHC Medicare", "methodology": "case rate", "standard_charge_dollar": 17926.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Amerihealth", "plan_name": "Amerihealth Medicare", "methodology": "case rate", "standard_charge_dollar": 17926.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Commercial", "methodology": "case rate", "standard_charge_dollar": 25808.78 }, { "payer_name": "Clover Health", "plan_name": "Clover Medicare", "methodology": "case rate", "standard_charge_dollar": 17926.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Coventry", "plan_name": "Coventry Auto", "methodology": "case rate", "standard_charge_dollar": 37303.93, "additional_payer_notes": "170.00% of Medicare Rates" }, { "payer_name": "Coventry", "plan_name": "Coventry Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 37303.93, "additional_payer_notes": "170.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "case rate", "standard_charge_dollar": 28526.54, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Fairprice Healthcare Holdings", "plan_name": "Fairprice Healthcare Holdings", "methodology": "case rate", "standard_charge_dollar": 35109.58, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon Medicare", "methodology": "case rate", "standard_charge_dollar": 17926.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon NJ Health Medicaid", "methodology": "case rate", "standard_charge_dollar": 11132.4 }, { "payer_name": "Humana", "plan_name": "Humana Military Tricare", "methodology": "case rate", "standard_charge_dollar": 17554.79, "additional_payer_notes": "80.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 21943.49, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 10960.2 }, { "payer_name": "UBH", "plan_name": "UBH Medicare", "methodology": "case rate", "standard_charge_dollar": 17926.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC All Payer (02-01-2023 to 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 29735.67 }, { "payer_name": "UHC", "plan_name": "UHC Oxford (02-01-2023 to 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 25914.63 }, { "payer_name": "UHC - Adhoc", "plan_name": "UHC - Adhoc All Payer", "methodology": "case rate", "standard_charge_dollar": 31565.04 }, { "payer_name": "UHC - Adhoc", "plan_name": "UHC - Adhoc Oxford", "methodology": "case rate", "standard_charge_dollar": 26704.95 }, { "payer_name": "Wellcare", "plan_name": "Wellcare Insurance Exchange", "methodology": "case rate", "standard_charge_dollar": 29623.71, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "case rate", "standard_charge_dollar": 17926.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup Medicare", "methodology": "case rate", "standard_charge_dollar": 17926.7, "additional_payer_notes": "100.00% of Medicare Rates" } ] } ] }, { "description": "ALTERATION IN CONSCIOUSNESS - SOI : 1", "code_information": [ { "code": "0521", "type": "APR-DRG" } ], "standard_charges": [ { "setting": "inpatient", "minimum": 7172.18, "maximum": 7889.4, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Better Health - Medi Medi", "methodology": "case rate", "standard_charge_dollar": 7889.4, "additional_payer_notes": "110% of State Medicaid Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Better Health Medicaid", "methodology": "case rate", "standard_charge_dollar": 7889.4, "additional_payer_notes": "110% of State Medicaid Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "case rate", "standard_charge_dollar": 7172.18, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "UBH", "plan_name": "UBH Medicaid", "methodology": "case rate", "standard_charge_dollar": 7172.18, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicaid (02/01/2023 to 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 7315.63, "additional_payer_notes": "102% of State Medicaid Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicaid", "methodology": "case rate", "standard_charge_dollar": 7172.18, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup Medicaid", "methodology": "case rate", "standard_charge_dollar": 7172.18, "additional_payer_notes": "100% of State Medicaid Rates" } ] } ] }, { "description": "PULMONARY EMBOLISM - SOI : 2", "code_information": [ { "code": "1342", "type": "APR-DRG" } ], "standard_charges": [ { "setting": "inpatient", "minimum": 9177.89, "maximum": 10095.68, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Better Health - Medi Medi", "methodology": "case rate", "standard_charge_dollar": 10095.68, "additional_payer_notes": "110% of State Medicaid Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Better Health Medicaid", "methodology": "case rate", "standard_charge_dollar": 10095.68, "additional_payer_notes": "110% of State Medicaid Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "case rate", "standard_charge_dollar": 9177.89, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "UBH", "plan_name": "UBH Medicaid", "methodology": "case rate", "standard_charge_dollar": 9177.89, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicaid (02/01/2023 to 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 9361.45, "additional_payer_notes": "102% of State Medicaid Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicaid", "methodology": "case rate", "standard_charge_dollar": 9177.89, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup Medicaid", "methodology": "case rate", "standard_charge_dollar": 9177.89, "additional_payer_notes": "100% of State Medicaid Rates" } ] } ] }, { "description": "BIOPSIES OF MUSCULOSKELETAL SYSTEM AND CONNECTIVE TISSUE WITH CC", "code_information": [ { "code": "478", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 29976.0, "minimum": 14232.09, "maximum": 54257.2659, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "case rate", "standard_charge_dollar": 54257.27, "additional_payer_notes": "181.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medical Rental Network", "methodology": "case rate", "standard_charge_dollar": 54257.27, "additional_payer_notes": "181.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "case rate", "standard_charge_dollar": 24376.9, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "ALLY-ALIGN (FKA SPARTAN PLAN NJ, INC.)", "plan_name": "ALLY-ALIGN (FKA SPARTAN PLAN NJ, INC.)", "methodology": "case rate", "standard_charge_dollar": 31475.21, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Americhoice (UHC)", "plan_name": "UHC Medicare", "methodology": "case rate", "standard_charge_dollar": 24376.9, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Amerihealth", "plan_name": "Amerihealth Medicare", "methodology": "case rate", "standard_charge_dollar": 24376.9, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Commercial", "methodology": "case rate", "standard_charge_dollar": 35978.1 }, { "payer_name": "Clover Health", "plan_name": "Clover Medicare", "methodology": "case rate", "standard_charge_dollar": 24376.9, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Coventry", "plan_name": "Coventry Auto", "methodology": "case rate", "standard_charge_dollar": 50959.86, "additional_payer_notes": "170.00% of Medicare Rates" }, { "payer_name": "Coventry", "plan_name": "Coventry Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 50959.86, "additional_payer_notes": "170.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "case rate", "standard_charge_dollar": 38969.31, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Fairprice Healthcare Holdings", "plan_name": "Fairprice Healthcare Holdings", "methodology": "case rate", "standard_charge_dollar": 47962.22, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon Medicare", "methodology": "case rate", "standard_charge_dollar": 24376.9, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon NJ Health Medicaid", "methodology": "case rate", "standard_charge_dollar": 14232.09 }, { "payer_name": "Humana", "plan_name": "Humana Military Tricare", "methodology": "case rate", "standard_charge_dollar": 23981.11, "additional_payer_notes": "80.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 29976.39, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 26125.1 }, { "payer_name": "UBH", "plan_name": "UBH Medicare", "methodology": "case rate", "standard_charge_dollar": 24376.9, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC All Payer (02-01-2023 to 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 41452.28 }, { "payer_name": "UHC", "plan_name": "UHC Oxford (02-01-2023 to 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 36125.65 }, { "payer_name": "UHC - Adhoc", "plan_name": "UHC - Adhoc All Payer", "methodology": "case rate", "standard_charge_dollar": 44002.47 }, { "payer_name": "UHC - Adhoc", "plan_name": "UHC - Adhoc Oxford", "methodology": "case rate", "standard_charge_dollar": 37227.37 }, { "payer_name": "Wellcare", "plan_name": "Wellcare Insurance Exchange", "methodology": "case rate", "standard_charge_dollar": 40468.13, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "case rate", "standard_charge_dollar": 24376.9, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup Medicare", "methodology": "case rate", "standard_charge_dollar": 24376.9, "additional_payer_notes": "100.00% of Medicare Rates" } ] } ] }, { "description": "HAND & WRIST PROCEDURES - SOI : 3", "code_information": [ { "code": "3163", "type": "APR-DRG" } ], "standard_charges": [ { "setting": "inpatient", "minimum": 21324.45, "maximum": 23456.9, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Better Health - Medi Medi", "methodology": "case rate", "standard_charge_dollar": 23456.9, "additional_payer_notes": "110% of State Medicaid Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Better Health Medicaid", "methodology": "case rate", "standard_charge_dollar": 23456.9, "additional_payer_notes": "110% of State Medicaid Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "case rate", "standard_charge_dollar": 21324.45, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "UBH", "plan_name": "UBH Medicaid", "methodology": "case rate", "standard_charge_dollar": 21324.45, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicaid (02/01/2023 to 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 21750.94, "additional_payer_notes": "102% of State Medicaid Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicaid", "methodology": "case rate", "standard_charge_dollar": 21324.45, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup Medicaid", "methodology": "case rate", "standard_charge_dollar": 21324.45, "additional_payer_notes": "100% of State Medicaid Rates" } ] } ] }, { "description": "Hc Strapping Shoulder", "code_information": [ { "code": "29240", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 396.9, "discounted_cash": 157.0, "minimum": 75.7682, "maximum": 396.9, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 333.45, "additional_payer_notes": "212.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medical Rental Network", "methodology": "fee schedule", "standard_charge_dollar": 333.45, "additional_payer_notes": "212.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 157.29, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "ALLY-ALIGN (FKA SPARTAN PLAN NJ, INC.)", "plan_name": "ALLY-ALIGN (FKA SPARTAN PLAN NJ, INC.)", "methodology": "fee schedule", "standard_charge_dollar": 165.15, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Americhoice (UHC)", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 157.29, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Amerihealth", "plan_name": "Amerihealth Medicare", "methodology": "fee schedule", "standard_charge_dollar": 157.29, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 231.14, "additional_payer_notes": "146.95% of Medicare Rates" }, { "payer_name": "Clover Health", "plan_name": "Clover Medicare", "methodology": "fee schedule", "standard_charge_dollar": 157.29, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Coventry", "plan_name": "Coventry Auto", "methodology": "fee schedule", "standard_charge_dollar": 314.58, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Coventry", "plan_name": "Coventry Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 314.58, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "fee schedule", "standard_charge_dollar": 220.21, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Fairprice Healthcare Holdings", "plan_name": "Fairprice Healthcare Holdings", "methodology": "fee schedule", "standard_charge_dollar": 251.66, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ HMO POS", "methodology": "fee schedule", "standard_charge_dollar": 278.88, "additional_payer_notes": "177.30% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ Indemnity", "methodology": "fee schedule", "standard_charge_dollar": 278.88, "additional_payer_notes": "177.30% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ PPO", "methodology": "fee schedule", "standard_charge_dollar": 278.88, "additional_payer_notes": "177.30% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon Medicare", "methodology": "fee schedule", "standard_charge_dollar": 157.29, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Military Tricare", "methodology": "fee schedule", "standard_charge_dollar": 125.83, "additional_payer_notes": "80.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 157.29, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 157.29, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC All Payer (02-01-2023 to 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 396.9 }, { "payer_name": "UHC", "plan_name": "UHC Oxford (02-01-2023 to 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 396.9 }, { "payer_name": "UHC - Adhoc", "plan_name": "UHC - Adhoc All Payer", "methodology": "case rate", "standard_charge_dollar": 396.9 }, { "payer_name": "UHC - Adhoc", "plan_name": "UHC - Adhoc Oxford", "methodology": "case rate", "standard_charge_dollar": 396.9 }, { "payer_name": "Wellcare", "plan_name": "Wellcare Insurance Exchange", "methodology": "fee schedule", "standard_charge_dollar": 212.34, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 157.29, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup Medicare", "methodology": "fee schedule", "standard_charge_dollar": 157.29, "additional_payer_notes": "100.00% of Medicare Rates" } ] } ] }, { "description": "MAJOR ESOPHAGEAL DISORDERS - SOI : 3", "code_information": [ { "code": "2423", "type": "APR-DRG" } ], "standard_charges": [ { "setting": "inpatient", "minimum": 12894.18, "maximum": 14183.59, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Better Health - Medi Medi", "methodology": "case rate", "standard_charge_dollar": 14183.59, "additional_payer_notes": "110% of State Medicaid Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Better Health Medicaid", "methodology": "case rate", "standard_charge_dollar": 14183.59, "additional_payer_notes": "110% of State Medicaid Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "case rate", "standard_charge_dollar": 12894.18, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "UBH", "plan_name": "UBH Medicaid", "methodology": "case rate", "standard_charge_dollar": 12894.18, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicaid (02/01/2023 to 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 13152.06, "additional_payer_notes": "102% of State Medicaid Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicaid", "methodology": "case rate", "standard_charge_dollar": 12894.18, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup Medicaid", "methodology": "case rate", "standard_charge_dollar": 12894.18, "additional_payer_notes": "100% of State Medicaid Rates" } ] } ] }, { "description": "Unlstd laps px hrnap hrnrphy", "code_information": [ { "code": "49659", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 13389.75, "discounted_cash": 7147.0, "minimum": 1715.0, "maximum": 13389.75, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 13389.75, "additional_payer_notes": "212.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medical Rental Network", "methodology": "fee schedule", "standard_charge_dollar": 13389.75, "additional_payer_notes": "212.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 7147.05, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "ALLY-ALIGN (FKA SPARTAN PLAN NJ, INC.)", "plan_name": "ALLY-ALIGN (FKA SPARTAN PLAN NJ, INC.)", "methodology": "fee schedule", "standard_charge_dollar": 7504.4, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Americhoice (UHC)", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 7147.05, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Amerihealth", "plan_name": "Amerihealth Medicare", "methodology": "fee schedule", "standard_charge_dollar": 7147.05, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 10502.59, "additional_payer_notes": "146.95% of Medicare Rates" }, { "payer_name": "Clover Health", "plan_name": "Clover Medicare", "methodology": "fee schedule", "standard_charge_dollar": 7147.05, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Coventry", "plan_name": "Coventry Auto", "methodology": "fee schedule", "standard_charge_dollar": 13389.75, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Coventry", "plan_name": "Coventry Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 13389.75, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "fee schedule", "standard_charge_dollar": 10005.87, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Fairprice Healthcare Holdings", "plan_name": "Fairprice Healthcare Holdings", "methodology": "fee schedule", "standard_charge_dollar": 11435.28, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ HMO POS", "methodology": "fee schedule", "standard_charge_dollar": 12671.72, "additional_payer_notes": "177.30% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ Indemnity", "methodology": "fee schedule", "standard_charge_dollar": 12671.72, "additional_payer_notes": "177.30% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ PPO", "methodology": "fee schedule", "standard_charge_dollar": 12671.72, "additional_payer_notes": "177.30% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon Medicare", "methodology": "fee schedule", "standard_charge_dollar": 7147.05, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Military Tricare", "methodology": "fee schedule", "standard_charge_dollar": 5717.64, "additional_payer_notes": "80.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 7147.05, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 7147.05, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC All Payer (02-01-2023 to 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 5667.0 }, { "payer_name": "UHC", "plan_name": "UHC Oxford (02-01-2023 to 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 5169.0 }, { "payer_name": "UHC - Adhoc", "plan_name": "UHC - Adhoc All Payer", "methodology": "case rate", "standard_charge_dollar": 6016.0 }, { "payer_name": "UHC - Adhoc", "plan_name": "UHC - Adhoc Oxford", "methodology": "case rate", "standard_charge_dollar": 5327.0 }, { "payer_name": "Wellcare", "plan_name": "Wellcare Insurance Exchange", "methodology": "fee schedule", "standard_charge_dollar": 9648.52, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 7147.05, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellchoice", "plan_name": "WELLCHOICE HMO of NJ (Empire) Commercial (HMO / HMO POS, PPO)", "methodology": "case rate", "standard_charge_dollar": 1715.0 }, { "payer_name": "Wellchoice", "plan_name": "WELLCHOICE HMO of NJ (Empire) Commercial (Indemnity)", "methodology": "case rate", "standard_charge_dollar": 1978.0 }, { "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup Medicare", "methodology": "fee schedule", "standard_charge_dollar": 7147.05, "additional_payer_notes": "100.00% of Medicare Rates" } ] } ] }, { "description": "Hc Episiotomy/Vag Rpr Oth/Thn Attending", "code_information": [ { "code": "59300", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 12834.6, "minimum": 2450.1251, "maximum": 10909.41, "payers_information": [ { "payer_name": "UHC", "plan_name": "UHC All Payer (02-01-2023 to 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 4415.0 }, { "payer_name": "UHC", "plan_name": "UHC Oxford (02-01-2023 to 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 4020.0 }, { "payer_name": "UHC - Adhoc", "plan_name": "UHC - Adhoc All Payer", "methodology": "case rate", "standard_charge_dollar": 4687.0 }, { "payer_name": "UHC - Adhoc", "plan_name": "UHC - Adhoc Oxford", "methodology": "case rate", "standard_charge_dollar": 4143.0 } ] } ] }, { "description": "Hc Injection Aa&/Strd Nerves Nrvtg Si Joint W/Img", "code_information": [ { "code": "64451", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 3294.5, "discounted_cash": 834.0, "minimum": 628.92, "maximum": 12321.04, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 1769.12, "additional_payer_notes": "212.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medical Rental Network", "methodology": "fee schedule", "standard_charge_dollar": 1769.12, "additional_payer_notes": "212.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 834.49, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "ALLY-ALIGN (FKA SPARTAN PLAN NJ, INC.)", "plan_name": "ALLY-ALIGN (FKA SPARTAN PLAN NJ, INC.)", "methodology": "fee schedule", "standard_charge_dollar": 876.21, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Americhoice (UHC)", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 834.49, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Amerihealth", "plan_name": "Amerihealth Medicare", "methodology": "fee schedule", "standard_charge_dollar": 834.49, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 1226.28, "additional_payer_notes": "146.95% of Medicare Rates" }, { "payer_name": "Clover Health", "plan_name": "Clover Medicare", "methodology": "fee schedule", "standard_charge_dollar": 834.49, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Coventry", "plan_name": "Coventry Auto", "methodology": "fee schedule", "standard_charge_dollar": 1668.98, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Coventry", "plan_name": "Coventry Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 1668.98, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "fee schedule", "standard_charge_dollar": 1168.29, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Fairprice Healthcare Holdings", "plan_name": "Fairprice Healthcare Holdings", "methodology": "fee schedule", "standard_charge_dollar": 1335.18, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ HMO POS", "methodology": "fee schedule", "standard_charge_dollar": 1479.55, "additional_payer_notes": "177.30% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ Indemnity", "methodology": "fee schedule", "standard_charge_dollar": 1479.55, "additional_payer_notes": "177.30% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ PPO", "methodology": "fee schedule", "standard_charge_dollar": 1479.55, "additional_payer_notes": "177.30% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon Medicare", "methodology": "fee schedule", "standard_charge_dollar": 834.49, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Military Tricare", "methodology": "fee schedule", "standard_charge_dollar": 667.59, "additional_payer_notes": "80.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 834.49, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 834.49, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC All Payer (02-01-2023 to 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 3147.0 }, { "payer_name": "UHC", "plan_name": "UHC Oxford (02-01-2023 to 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 2297.0 }, { "payer_name": "UHC - Adhoc", "plan_name": "UHC - Adhoc All Payer", "methodology": "case rate", "standard_charge_dollar": 3294.5 }, { "payer_name": "UHC - Adhoc", "plan_name": "UHC - Adhoc Oxford", "methodology": "case rate", "standard_charge_dollar": 2367.0 }, { "payer_name": "Wellcare", "plan_name": "Wellcare Insurance Exchange", "methodology": "fee schedule", "standard_charge_dollar": 1126.56, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 834.49, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellchoice", "plan_name": "WELLCHOICE HMO of NJ (Empire) Commercial (HMO / HMO POS, PPO)", "methodology": "case rate", "standard_charge_dollar": 1715.0 }, { "payer_name": "Wellchoice", "plan_name": "WELLCHOICE HMO of NJ (Empire) Commercial (Indemnity)", "methodology": "case rate", "standard_charge_dollar": 1978.0 }, { "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup Medicare", "methodology": "fee schedule", "standard_charge_dollar": 834.49, "additional_payer_notes": "100.00% of Medicare Rates" } ] } ] }, { "description": "OTHER DISORDERS OF NERVOUS SYSTEM WITH CC", "code_information": [ { "code": "092", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 13378.0, "minimum": 5890.28, "maximum": 24215.9719, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "case rate", "standard_charge_dollar": 24215.97, "additional_payer_notes": "181.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medical Rental Network", "methodology": "case rate", "standard_charge_dollar": 24215.97, "additional_payer_notes": "181.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "case rate", "standard_charge_dollar": 11049.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "ALLY-ALIGN (FKA SPARTAN PLAN NJ, INC.)", "plan_name": "ALLY-ALIGN (FKA SPARTAN PLAN NJ, INC.)", "methodology": "case rate", "standard_charge_dollar": 14047.94, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Americhoice (UHC)", "plan_name": "UHC Medicare", "methodology": "case rate", "standard_charge_dollar": 11049.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Amerihealth", "plan_name": "Amerihealth Medicare", "methodology": "case rate", "standard_charge_dollar": 11049.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Commercial", "methodology": "case rate", "standard_charge_dollar": 14966.49 }, { "payer_name": "Clover Health", "plan_name": "Clover Medicare", "methodology": "case rate", "standard_charge_dollar": 11049.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Coventry", "plan_name": "Coventry Auto", "methodology": "case rate", "standard_charge_dollar": 22744.28, "additional_payer_notes": "170.00% of Medicare Rates" }, { "payer_name": "Coventry", "plan_name": "Coventry Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 22744.28, "additional_payer_notes": "170.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "case rate", "standard_charge_dollar": 17392.69, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Fairprice Healthcare Holdings", "plan_name": "Fairprice Healthcare Holdings", "methodology": "case rate", "standard_charge_dollar": 21406.38, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon Medicare", "methodology": "case rate", "standard_charge_dollar": 11049.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon NJ Health Medicaid", "methodology": "case rate", "standard_charge_dollar": 5890.28 }, { "payer_name": "Humana", "plan_name": "Humana Military Tricare", "methodology": "case rate", "standard_charge_dollar": 10703.19, "additional_payer_notes": "80.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 13378.99, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 12417.7 }, { "payer_name": "UBH", "plan_name": "UBH Medicare", "methodology": "case rate", "standard_charge_dollar": 11049.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC All Payer (02-01-2023 to 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 17243.69 }, { "payer_name": "UHC", "plan_name": "UHC Oxford (02-01-2023 to 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 15027.87 }, { "payer_name": "UHC - Adhoc", "plan_name": "UHC - Adhoc All Payer", "methodology": "case rate", "standard_charge_dollar": 18304.54 }, { "payer_name": "UHC - Adhoc", "plan_name": "UHC - Adhoc Oxford", "methodology": "case rate", "standard_charge_dollar": 15486.17 }, { "payer_name": "Wellcare", "plan_name": "Wellcare Insurance Exchange", "methodology": "case rate", "standard_charge_dollar": 18061.64, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "case rate", "standard_charge_dollar": 11049.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup Medicare", "methodology": "case rate", "standard_charge_dollar": 11049.7, "additional_payer_notes": "100.00% of Medicare Rates" } ] } ] }, { "description": "Hc Apply Long Leg Splint", "code_information": [ { "code": "29505", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 646.85, "discounted_cash": 192.0, "minimum": 123.4837, "maximum": 646.85, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 407.25, "additional_payer_notes": "212.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medical Rental Network", "methodology": "fee schedule", "standard_charge_dollar": 407.25, "additional_payer_notes": "212.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 192.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "ALLY-ALIGN (FKA SPARTAN PLAN NJ, INC.)", "plan_name": "ALLY-ALIGN (FKA SPARTAN PLAN NJ, INC.)", "methodology": "fee schedule", "standard_charge_dollar": 201.71, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Americhoice (UHC)", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 192.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Amerihealth", "plan_name": "Amerihealth Medicare", "methodology": "fee schedule", "standard_charge_dollar": 192.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 282.29, "additional_payer_notes": "146.95% of Medicare Rates" }, { "payer_name": "Clover Health", "plan_name": "Clover Medicare", "methodology": "fee schedule", "standard_charge_dollar": 192.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Coventry", "plan_name": "Coventry Auto", "methodology": "fee schedule", "standard_charge_dollar": 384.2, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Coventry", "plan_name": "Coventry Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 384.2, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "fee schedule", "standard_charge_dollar": 268.94, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Fairprice Healthcare Holdings", "plan_name": "Fairprice Healthcare Holdings", "methodology": "fee schedule", "standard_charge_dollar": 307.36, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ HMO POS", "methodology": "fee schedule", "standard_charge_dollar": 340.59, "additional_payer_notes": "177.30% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ Indemnity", "methodology": "fee schedule", "standard_charge_dollar": 340.59, "additional_payer_notes": "177.30% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ PPO", "methodology": "fee schedule", "standard_charge_dollar": 340.59, "additional_payer_notes": "177.30% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon Medicare", "methodology": "fee schedule", "standard_charge_dollar": 192.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Military Tricare", "methodology": "fee schedule", "standard_charge_dollar": 153.68, "additional_payer_notes": "80.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 192.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 192.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC All Payer (02-01-2023 to 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 646.85 }, { "payer_name": "UHC", "plan_name": "UHC Oxford (02-01-2023 to 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 646.85 }, { "payer_name": "UHC - Adhoc", "plan_name": "UHC - Adhoc All Payer", "methodology": "case rate", "standard_charge_dollar": 646.85 }, { "payer_name": "UHC - Adhoc", "plan_name": "UHC - Adhoc Oxford", "methodology": "case rate", "standard_charge_dollar": 646.85 }, { "payer_name": "Wellcare", "plan_name": "Wellcare Insurance Exchange", "methodology": "fee schedule", "standard_charge_dollar": 259.34, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 192.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup Medicare", "methodology": "fee schedule", "standard_charge_dollar": 192.1, "additional_payer_notes": "100.00% of Medicare Rates" } ] } ] }, { "description": "MULTIPLE SCLEROSIS, OTHER DEMYELINATING DISEASE AND INFLAMMATORY NEUROPATHIES- SOI : 4", "code_information": [ { "code": "0434", "type": "APR-DRG" } ], "standard_charges": [ { "setting": "inpatient", "minimum": 39846.47, "maximum": 43831.12, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Better Health - Medi Medi", "methodology": "case rate", "standard_charge_dollar": 43831.12, "additional_payer_notes": "110% of State Medicaid Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Better Health Medicaid", "methodology": "case rate", "standard_charge_dollar": 43831.12, "additional_payer_notes": "110% of State Medicaid Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "case rate", "standard_charge_dollar": 39846.47, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "UBH", "plan_name": "UBH Medicaid", "methodology": "case rate", "standard_charge_dollar": 39846.47, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicaid (02/01/2023 to 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 40643.4, "additional_payer_notes": "102% of State Medicaid Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicaid", "methodology": "case rate", "standard_charge_dollar": 39846.47, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup Medicaid", "methodology": "case rate", "standard_charge_dollar": 39846.47, "additional_payer_notes": "100% of State Medicaid Rates" } ] } ] }, { "description": "MAJOR O.R. PROCEDURES FOR LYMPHATICHEMATOPOIETICOTHER NEOPLASMS - SOI : 1", "code_information": [ { "code": "6801", "type": "APR-DRG" } ], "standard_charges": [ { "setting": "inpatient", "minimum": 19557.15, "maximum": 21512.86, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Better Health - Medi Medi", "methodology": "case rate", "standard_charge_dollar": 21512.86, "additional_payer_notes": "110% of State Medicaid Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Better Health Medicaid", "methodology": "case rate", "standard_charge_dollar": 21512.86, "additional_payer_notes": "110% of State Medicaid Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "case rate", "standard_charge_dollar": 19557.15, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "UBH", "plan_name": "UBH Medicaid", "methodology": "case rate", "standard_charge_dollar": 19557.15, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicaid (02/01/2023 to 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 19948.29, "additional_payer_notes": "102% of State Medicaid Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicaid", "methodology": "case rate", "standard_charge_dollar": 19557.15, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup Medicaid", "methodology": "case rate", "standard_charge_dollar": 19557.15, "additional_payer_notes": "100% of State Medicaid Rates" } ] } ] }, { "description": "Hc Assay Of Uric Acid, Blood", "code_information": [ { "code": "84550", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 67.0, "discounted_cash": 4.0, "minimum": 2.71, "maximum": 56.95, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 9.58, "additional_payer_notes": "212.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medical Rental Network", "methodology": "fee schedule", "standard_charge_dollar": 9.58, "additional_payer_notes": "212.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 4.52, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "ALLY-ALIGN (FKA SPARTAN PLAN NJ, INC.)", "plan_name": "ALLY-ALIGN (FKA SPARTAN PLAN NJ, INC.)", "methodology": "fee schedule", "standard_charge_dollar": 4.75, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Americhoice (UHC)", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 4.52, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Amerihealth", "plan_name": "Amerihealth Medicare", "methodology": "fee schedule", "standard_charge_dollar": 4.52, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 6.55, "additional_payer_notes": "Laboratory - 145.00% of Medicare Rates" }, { "payer_name": "Clover Health", "plan_name": "Clover Medicare", "methodology": "fee schedule", "standard_charge_dollar": 4.52, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Coventry", "plan_name": "Coventry Auto", "methodology": "fee schedule", "standard_charge_dollar": 9.04, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Coventry", "plan_name": "Coventry Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 9.04, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "fee schedule", "standard_charge_dollar": 6.33, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Fairprice Healthcare Holdings", "plan_name": "Fairprice Healthcare Holdings", "methodology": "fee schedule", "standard_charge_dollar": 5.42, "additional_payer_notes": "Laboratory - 120.00% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ HMO POS", "methodology": "fee schedule", "standard_charge_dollar": 47.3, "additional_payer_notes": "177.30% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ Indemnity", "methodology": "fee schedule", "standard_charge_dollar": 47.3, "additional_payer_notes": "177.30% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ PPO", "methodology": "fee schedule", "standard_charge_dollar": 47.3, "additional_payer_notes": "177.30% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon Medicare", "methodology": "fee schedule", "standard_charge_dollar": 4.52, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Military Tricare", "methodology": "fee schedule", "standard_charge_dollar": 3.62, "additional_payer_notes": "80.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 4.52, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 4.52, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC All Payer (02-01-2023 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 2.71 }, { "payer_name": "UHC", "plan_name": "UHC Medicaid (02/01/2023 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 3.62 }, { "payer_name": "UHC", "plan_name": "UHC Oxford (02-01-2023 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 2.71 }, { "payer_name": "UHC - Adhoc", "plan_name": "UHC - Adhoc All Payer", "methodology": "fee schedule", "standard_charge_dollar": 4.52 }, { "payer_name": "UHC - Adhoc", "plan_name": "UHC - Adhoc Oxford", "methodology": "fee schedule", "standard_charge_dollar": 4.52 }, { "payer_name": "Wellcare", "plan_name": "Wellcare Insurance Exchange", "methodology": "fee schedule", "standard_charge_dollar": 6.1, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 4.52, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup Medicaid", "methodology": "percent of total billed charges", "standard_charge_percentage": 19.09, "median_amount": 12.5, "10th_percentile": 4.52, "90th_percentile": 12.79, "count": "1 through 10" }, { "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup Medicare", "methodology": "fee schedule", "standard_charge_dollar": 4.52, "additional_payer_notes": "100.00% of Medicare Rates" } ] } ] }, { "description": "CRANIOTOMY FOR MULTIPLE SIGNIFICANT TRAUMA - SOI : 1", "code_information": [ { "code": "9101", "type": "APR-DRG" } ], "standard_charges": [ { "setting": "inpatient", "minimum": 33095.84, "maximum": 36405.42, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Better Health - Medi Medi", "methodology": "case rate", "standard_charge_dollar": 36405.42, "additional_payer_notes": "110% of State Medicaid Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Better Health Medicaid", "methodology": "case rate", "standard_charge_dollar": 36405.42, "additional_payer_notes": "110% of State Medicaid Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "case rate", "standard_charge_dollar": 33095.84, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "UBH", "plan_name": "UBH Medicaid", "methodology": "case rate", "standard_charge_dollar": 33095.84, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicaid (02/01/2023 to 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 33757.75, "additional_payer_notes": "102% of State Medicaid Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicaid", "methodology": "case rate", "standard_charge_dollar": 33095.84, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup Medicaid", "methodology": "case rate", "standard_charge_dollar": 33095.84, "additional_payer_notes": "100% of State Medicaid Rates" } ] } ] }, { "description": "CHRONIC KIDNEY DISEASE - SOI : 4", "code_information": [ { "code": "4704", "type": "APR-DRG" } ], "standard_charges": [ { "setting": "inpatient", "minimum": 20736.6, "maximum": 22810.26, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Better Health - Medi Medi", "methodology": "case rate", "standard_charge_dollar": 22810.26, "additional_payer_notes": "110% of State Medicaid Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Better Health Medicaid", "methodology": "case rate", "standard_charge_dollar": 22810.26, "additional_payer_notes": "110% of State Medicaid Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "case rate", "standard_charge_dollar": 20736.6, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "UBH", "plan_name": "UBH Medicaid", "methodology": "case rate", "standard_charge_dollar": 20736.6, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicaid (02/01/2023 to 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 21151.33, "additional_payer_notes": "102% of State Medicaid Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicaid", "methodology": "case rate", "standard_charge_dollar": 20736.6, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup Medicaid", "methodology": "case rate", "standard_charge_dollar": 20736.6, "additional_payer_notes": "100% of State Medicaid Rates" } ] } ] }, { "description": "CARDIAC VALVE AND OTHER MAJOR CARDIOTHORACIC PROCEDURES WITH CARDIAC CATHETERIZATION WITH CC", "code_information": [ { "code": "217", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 77543.0, "minimum": 39731.45, "maximum": 140354.6038, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "case rate", "standard_charge_dollar": 140354.6, "additional_payer_notes": "181.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medical Rental Network", "methodology": "case rate", "standard_charge_dollar": 140354.6, "additional_payer_notes": "181.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "case rate", "standard_charge_dollar": 62572.4, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "ALLY-ALIGN (FKA SPARTAN PLAN NJ, INC.)", "plan_name": "ALLY-ALIGN (FKA SPARTAN PLAN NJ, INC.)", "methodology": "case rate", "standard_charge_dollar": 81421.18, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Americhoice (UHC)", "plan_name": "UHC Medicare", "methodology": "case rate", "standard_charge_dollar": 62572.4, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Amerihealth", "plan_name": "Amerihealth Medicare", "methodology": "case rate", "standard_charge_dollar": 62572.4, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Commercial", "methodology": "case rate", "standard_charge_dollar": 96196.64 }, { "payer_name": "Clover Health", "plan_name": "Clover Medicare", "methodology": "case rate", "standard_charge_dollar": 62572.4, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Coventry", "plan_name": "Coventry Auto", "methodology": "case rate", "standard_charge_dollar": 131824.77, "additional_payer_notes": "170.00% of Medicare Rates" }, { "payer_name": "Coventry", "plan_name": "Coventry Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 131824.77, "additional_payer_notes": "170.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "case rate", "standard_charge_dollar": 100807.17, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Fairprice Healthcare Holdings", "plan_name": "Fairprice Healthcare Holdings", "methodology": "case rate", "standard_charge_dollar": 124070.37, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon Medicare", "methodology": "case rate", "standard_charge_dollar": 62572.4, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon NJ Health Medicaid", "methodology": "case rate", "standard_charge_dollar": 39731.45 }, { "payer_name": "Humana", "plan_name": "Humana Military Tricare", "methodology": "case rate", "standard_charge_dollar": 62035.18, "additional_payer_notes": "80.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 77543.98, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 68839.8 }, { "payer_name": "UBH", "plan_name": "UBH Medicare", "methodology": "case rate", "standard_charge_dollar": 62572.4, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC All Payer (02-01-2023 to 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 110833.26 }, { "payer_name": "UHC", "plan_name": "UHC Oxford (02-01-2023 to 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 96591.16 }, { "payer_name": "UHC - Adhoc", "plan_name": "UHC - Adhoc All Payer", "methodology": "case rate", "standard_charge_dollar": 117651.84 }, { "payer_name": "UHC - Adhoc", "plan_name": "UHC - Adhoc Oxford", "methodology": "case rate", "standard_charge_dollar": 99536.89 }, { "payer_name": "Wellcare", "plan_name": "Wellcare Insurance Exchange", "methodology": "case rate", "standard_charge_dollar": 104684.37, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "case rate", "standard_charge_dollar": 62572.4, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup Medicare", "methodology": "case rate", "standard_charge_dollar": 62572.4, "additional_payer_notes": "100.00% of Medicare Rates" } ] } ] }, { "description": "Hc Allergen Spec Ige Qualit,Multi", "code_information": [ { "code": "86005", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 37.0, "discounted_cash": 7.0, "minimum": 4.78, "maximum": 31.45, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 16.9, "additional_payer_notes": "212.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medical Rental Network", "methodology": "fee schedule", "standard_charge_dollar": 16.9, "additional_payer_notes": "212.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 7.97, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "ALLY-ALIGN (FKA SPARTAN PLAN NJ, INC.)", "plan_name": "ALLY-ALIGN (FKA SPARTAN PLAN NJ, INC.)", "methodology": "fee schedule", "standard_charge_dollar": 8.37, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Americhoice (UHC)", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 7.97, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Amerihealth", "plan_name": "Amerihealth Medicare", "methodology": "fee schedule", "standard_charge_dollar": 7.97, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 11.56, "additional_payer_notes": "Laboratory - 145.00% of Medicare Rates" }, { "payer_name": "Clover Health", "plan_name": "Clover Medicare", "methodology": "fee schedule", "standard_charge_dollar": 7.97, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Coventry", "plan_name": "Coventry Auto", "methodology": "fee schedule", "standard_charge_dollar": 15.94, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Coventry", "plan_name": "Coventry Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 15.94, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "fee schedule", "standard_charge_dollar": 11.16, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Fairprice Healthcare Holdings", "plan_name": "Fairprice Healthcare Holdings", "methodology": "fee schedule", "standard_charge_dollar": 9.56, "additional_payer_notes": "Laboratory - 120.00% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ HMO POS", "methodology": "fee schedule", "standard_charge_dollar": 26.12, "additional_payer_notes": "177.30% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ Indemnity", "methodology": "fee schedule", "standard_charge_dollar": 26.12, "additional_payer_notes": "177.30% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ PPO", "methodology": "fee schedule", "standard_charge_dollar": 26.12, "additional_payer_notes": "177.30% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon Medicare", "methodology": "fee schedule", "standard_charge_dollar": 7.97, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Military Tricare", "methodology": "fee schedule", "standard_charge_dollar": 6.38, "additional_payer_notes": "80.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 7.97, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 7.97, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC All Payer (02-01-2023 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 4.78 }, { "payer_name": "UHC", "plan_name": "UHC Medicaid (02/01/2023 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 6.38 }, { "payer_name": "UHC", "plan_name": "UHC Oxford (02-01-2023 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 4.78 }, { "payer_name": "UHC - Adhoc", "plan_name": "UHC - Adhoc All Payer", "methodology": "fee schedule", "standard_charge_dollar": 7.97 }, { "payer_name": "UHC - Adhoc", "plan_name": "UHC - Adhoc Oxford", "methodology": "fee schedule", "standard_charge_dollar": 7.97 }, { "payer_name": "Wellcare", "plan_name": "Wellcare Insurance Exchange", "methodology": "fee schedule", "standard_charge_dollar": 10.76, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 7.97, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup Medicare", "methodology": "fee schedule", "standard_charge_dollar": 7.97, "additional_payer_notes": "100.00% of Medicare Rates" } ] } ] }, { "description": "Hc Ct Upper Extremity W Contrast", "code_information": [ { "code": "73201", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 1578.79, "discounted_cash": 412.0, "minimum": 301.391, "maximum": 1341.9715, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 874.37, "additional_payer_notes": "212.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medical Rental Network", "methodology": "fee schedule", "standard_charge_dollar": 874.37, "additional_payer_notes": "212.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 412.44, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "ALLY-ALIGN (FKA SPARTAN PLAN NJ, INC.)", "plan_name": "ALLY-ALIGN (FKA SPARTAN PLAN NJ, INC.)", "methodology": "fee schedule", "standard_charge_dollar": 433.06, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Americhoice (UHC)", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 412.44, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Amerihealth", "plan_name": "Amerihealth HMO", "methodology": "fee schedule", "standard_charge_dollar": 446.52 }, { "payer_name": "Amerihealth", "plan_name": "Amerihealth Medicare", "methodology": "fee schedule", "standard_charge_dollar": 412.44, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 606.08, "additional_payer_notes": "146.95% of Medicare Rates" }, { "payer_name": "Clover Health", "plan_name": "Clover Medicare", "methodology": "fee schedule", "standard_charge_dollar": 412.44, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Coventry", "plan_name": "Coventry Auto", "methodology": "fee schedule", "standard_charge_dollar": 824.88, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Coventry", "plan_name": "Coventry Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 824.88, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "fee schedule", "standard_charge_dollar": 577.42, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Fairprice Healthcare Holdings", "plan_name": "Fairprice Healthcare Holdings", "methodology": "fee schedule", "standard_charge_dollar": 659.9, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ HMO POS", "methodology": "fee schedule", "standard_charge_dollar": 731.26, "additional_payer_notes": "177.30% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ Indemnity", "methodology": "fee schedule", "standard_charge_dollar": 731.26, "additional_payer_notes": "177.30% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ PPO", "methodology": "fee schedule", "standard_charge_dollar": 731.26, "additional_payer_notes": "177.30% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon Medicare", "methodology": "fee schedule", "standard_charge_dollar": 412.44, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon NJ Health Medicaid", "methodology": "percent of total billed charges", "standard_charge_percentage": 19.58, "median_amount": 309.13, "10th_percentile": 309.13, "90th_percentile": 309.13, "count": "1 through 10" }, { "payer_name": "Humana", "plan_name": "Humana Military Tricare", "methodology": "fee schedule", "standard_charge_dollar": 329.95, "additional_payer_notes": "80.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 412.44, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 412.44, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC All Payer (02-01-2023 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 552.18 }, { "payer_name": "UHC", "plan_name": "UHC Oxford (02-01-2023 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 552.18 }, { "payer_name": "UHC - Adhoc", "plan_name": "UHC - Adhoc All Payer", "methodology": "fee schedule", "standard_charge_dollar": 368.12 }, { "payer_name": "UHC - Adhoc", "plan_name": "UHC - Adhoc Oxford", "methodology": "fee schedule", "standard_charge_dollar": 368.12 }, { "payer_name": "Wellcare", "plan_name": "Wellcare Insurance Exchange", "methodology": "fee schedule", "standard_charge_dollar": 556.79, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 412.44, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup Medicare", "methodology": "fee schedule", "standard_charge_dollar": 412.44, "additional_payer_notes": "100.00% of Medicare Rates" } ] } ] }, { "description": "Hc Radex Spine Cervical 2 Or 3 Views", "code_information": [ { "code": "72040", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 686.2, "discounted_cash": 102.0, "minimum": 54.81, "maximum": 583.27, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 218.08, "additional_payer_notes": "212.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medical Rental Network", "methodology": "fee schedule", "standard_charge_dollar": 218.08, "additional_payer_notes": "212.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 102.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "ALLY-ALIGN (FKA SPARTAN PLAN NJ, INC.)", "plan_name": "ALLY-ALIGN (FKA SPARTAN PLAN NJ, INC.)", "methodology": "fee schedule", "standard_charge_dollar": 108.01, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Americhoice (UHC)", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 102.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Amerihealth", "plan_name": "Amerihealth HMO", "methodology": "fee schedule", "standard_charge_dollar": 54.81 }, { "payer_name": "Amerihealth", "plan_name": "Amerihealth Medicare", "methodology": "fee schedule", "standard_charge_dollar": 102.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 151.17, "additional_payer_notes": "146.95% of Medicare Rates" }, { "payer_name": "Clover Health", "plan_name": "Clover Medicare", "methodology": "fee schedule", "standard_charge_dollar": 102.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Coventry", "plan_name": "Coventry Auto", "methodology": "fee schedule", "standard_charge_dollar": 205.74, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Coventry", "plan_name": "Coventry Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 205.74, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "fee schedule", "standard_charge_dollar": 144.02, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Fairprice Healthcare Holdings", "plan_name": "Fairprice Healthcare Holdings", "methodology": "fee schedule", "standard_charge_dollar": 164.59, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ HMO POS", "methodology": "fee schedule", "standard_charge_dollar": 182.39, "additional_payer_notes": "177.30% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ Indemnity", "methodology": "fee schedule", "standard_charge_dollar": 182.39, "additional_payer_notes": "177.30% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ PPO", "methodology": "fee schedule", "standard_charge_dollar": 182.39, "additional_payer_notes": "177.30% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon Medicare", "methodology": "fee schedule", "standard_charge_dollar": 102.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon NJ Health Medicaid", "methodology": "percent of total billed charges", "standard_charge_percentage": 19.58, "median_amount": 134.36, "10th_percentile": 134.36, "90th_percentile": 134.36, "count": "31" }, { "payer_name": "Humana", "plan_name": "Humana Military Tricare", "methodology": "fee schedule", "standard_charge_dollar": 82.3, "additional_payer_notes": "80.00% of Medicare Rates" }, { "payer_name": "Keenan", "plan_name": "Keenan", "methodology": "percent of total billed charges", "standard_charge_percentage": 30.0, "median_amount": 502.01, "10th_percentile": 502.01, "90th_percentile": 502.01, "count": "1 through 10" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 102.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 102.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC All Payer (02-01-2023 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 121.35 }, { "payer_name": "UHC", "plan_name": "UHC Medicaid (02/01/2023 to 12-31-2026)", "methodology": "percent of total billed charges", "standard_charge_percentage": 19.47, "median_amount": 130.54, "10th_percentile": 130.54, "90th_percentile": 130.54, "count": "1 through 10" }, { "payer_name": "UHC", "plan_name": "UHC Oxford (02-01-2023 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 121.35 }, { "payer_name": "UHC - Adhoc", "plan_name": "UHC - Adhoc All Payer", "methodology": "fee schedule", "standard_charge_dollar": 80.9 }, { "payer_name": "UHC - Adhoc", "plan_name": "UHC - Adhoc Oxford", "methodology": "fee schedule", "standard_charge_dollar": 80.9 }, { "payer_name": "Wellcare", "plan_name": "Wellcare Insurance Exchange", "methodology": "fee schedule", "standard_charge_dollar": 138.87, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 102.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup Medicaid", "methodology": "percent of total billed charges", "standard_charge_percentage": 19.09, "median_amount": 127.98, "10th_percentile": 127.98, "90th_percentile": 127.98, "count": "1 through 10" }, { "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup Medicare", "methodology": "fee schedule", "standard_charge_dollar": 102.87, "additional_payer_notes": "100.00% of Medicare Rates" } ] } ] }, { "description": "Hc Vascular Embolization Or Occlusion Venous Rs&I", "code_information": [ { "code": "37241", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 48345.2, "discounted_cash": 13647.0, "minimum": 2472.0, "maximum": 38676.16, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 28932.91, "additional_payer_notes": "212.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medical Rental Network", "methodology": "fee schedule", "standard_charge_dollar": 28932.91, "additional_payer_notes": "212.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 13647.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "ALLY-ALIGN (FKA SPARTAN PLAN NJ, INC.)", "plan_name": "ALLY-ALIGN (FKA SPARTAN PLAN NJ, INC.)", "methodology": "fee schedule", "standard_charge_dollar": 14329.98, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Americhoice (UHC)", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 13647.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Amerihealth", "plan_name": "Amerihealth Medicare", "methodology": "fee schedule", "standard_charge_dollar": 13647.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 20055.15, "additional_payer_notes": "146.95% of Medicare Rates" }, { "payer_name": "Clover Health", "plan_name": "Clover Medicare", "methodology": "fee schedule", "standard_charge_dollar": 13647.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Coventry", "plan_name": "Coventry Auto", "methodology": "fee schedule", "standard_charge_dollar": 27295.2, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Coventry", "plan_name": "Coventry Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 27295.2, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "fee schedule", "standard_charge_dollar": 19106.64, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Fairprice Healthcare Holdings", "plan_name": "Fairprice Healthcare Holdings", "methodology": "fee schedule", "standard_charge_dollar": 21836.16, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ HMO POS", "methodology": "fee schedule", "standard_charge_dollar": 24197.19, "additional_payer_notes": "177.30% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ Indemnity", "methodology": "fee schedule", "standard_charge_dollar": 24197.19, "additional_payer_notes": "177.30% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ PPO", "methodology": "fee schedule", "standard_charge_dollar": 24197.19, "additional_payer_notes": "177.30% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon Medicare", "methodology": "fee schedule", "standard_charge_dollar": 13647.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Military Tricare", "methodology": "fee schedule", "standard_charge_dollar": 10918.08, "additional_payer_notes": "80.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 13647.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 13647.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC All Payer (02-01-2023 to 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 7566.0 }, { "payer_name": "UHC", "plan_name": "UHC Oxford (02-01-2023 to 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 6317.0 }, { "payer_name": "UHC - Adhoc", "plan_name": "UHC - Adhoc All Payer", "methodology": "case rate", "standard_charge_dollar": 8031.0 }, { "payer_name": "UHC - Adhoc", "plan_name": "UHC - Adhoc Oxford", "methodology": "case rate", "standard_charge_dollar": 6510.0 }, { "payer_name": "Wellcare", "plan_name": "Wellcare Insurance Exchange", "methodology": "fee schedule", "standard_charge_dollar": 18424.26, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 13647.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellchoice", "plan_name": "WELLCHOICE HMO of NJ (Empire) Commercial (HMO / HMO POS, PPO)", "methodology": "case rate", "standard_charge_dollar": 2472.0 }, { "payer_name": "Wellchoice", "plan_name": "WELLCHOICE HMO of NJ (Empire) Commercial (Indemnity)", "methodology": "case rate", "standard_charge_dollar": 2753.0 }, { "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup Medicare", "methodology": "fee schedule", "standard_charge_dollar": 13647.6, "additional_payer_notes": "100.00% of Medicare Rates" } ] } ] }, { "description": "Hc Tiss Exam Molecular Study, Ea Preparation", "code_information": [ { "code": "88387", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 341.36, "minimum": 4.33, "maximum": 290.156, "payers_information": [ { "payer_name": "UHC", "plan_name": "UHC All Payer (02-01-2023 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 4.33 }, { "payer_name": "UHC", "plan_name": "UHC Medicaid (02/01/2023 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 26.24 }, { "payer_name": "UHC", "plan_name": "UHC Oxford (02-01-2023 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 4.33 }, { "payer_name": "UHC - Adhoc", "plan_name": "UHC - Adhoc All Payer", "methodology": "fee schedule", "standard_charge_dollar": 7.22 }, { "payer_name": "UHC - Adhoc", "plan_name": "UHC - Adhoc Oxford", "methodology": "fee schedule", "standard_charge_dollar": 7.22 } ] } ] }, { "description": "Hc Eia Hiv-1/Hiv-2 Screen - G0432 - 30200255", "code_information": [ { "code": "G0432", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 99.0, "discounted_cash": 19.0, "minimum": 11.74, "maximum": 84.15, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 19.57, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "ALLY-ALIGN (FKA SPARTAN PLAN NJ, INC.)", "plan_name": "ALLY-ALIGN (FKA SPARTAN PLAN NJ, INC.)", "methodology": "fee schedule", "standard_charge_dollar": 20.55, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Americhoice (UHC)", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 19.57, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Amerihealth", "plan_name": "Amerihealth Medicare", "methodology": "fee schedule", "standard_charge_dollar": 19.57, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 28.38, "additional_payer_notes": "A Indicator - 155.00% of Medicare Rates" }, { "payer_name": "Clover Health", "plan_name": "Clover Medicare", "methodology": "fee schedule", "standard_charge_dollar": 19.57, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Coventry", "plan_name": "Coventry Auto", "methodology": "fee schedule", "standard_charge_dollar": 39.14, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Coventry", "plan_name": "Coventry Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 39.14, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "fee schedule", "standard_charge_dollar": 27.4, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Fairprice Healthcare Holdings", "plan_name": "Fairprice Healthcare Holdings", "methodology": "fee schedule", "standard_charge_dollar": 23.48, "additional_payer_notes": "Laboratory - 120.00% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ HMO POS", "methodology": "fee schedule", "standard_charge_dollar": 69.89, "additional_payer_notes": "177.30% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ Indemnity", "methodology": "fee schedule", "standard_charge_dollar": 69.89, "additional_payer_notes": "177.30% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ PPO", "methodology": "fee schedule", "standard_charge_dollar": 69.89, "additional_payer_notes": "177.30% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon Medicare", "methodology": "fee schedule", "standard_charge_dollar": 19.57, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Military Tricare", "methodology": "fee schedule", "standard_charge_dollar": 15.66, "additional_payer_notes": "80.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 19.57, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 19.57, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC All Payer (02-01-2023 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 11.74 }, { "payer_name": "UHC", "plan_name": "UHC Medicaid (02/01/2023 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 15.66 }, { "payer_name": "UHC", "plan_name": "UHC Oxford (02-01-2023 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 11.74 }, { "payer_name": "UHC - Adhoc", "plan_name": "UHC - Adhoc All Payer", "methodology": "fee schedule", "standard_charge_dollar": 19.57 }, { "payer_name": "UHC - Adhoc", "plan_name": "UHC - Adhoc Oxford", "methodology": "fee schedule", "standard_charge_dollar": 19.57 }, { "payer_name": "Wellcare", "plan_name": "Wellcare Insurance Exchange", "methodology": "fee schedule", "standard_charge_dollar": 26.42, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 19.57, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup Medicare", "methodology": "fee schedule", "standard_charge_dollar": 19.57, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 41.49, "additional_payer_notes": "212.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medical Rental Network", "methodology": "fee schedule", "standard_charge_dollar": 41.49, "additional_payer_notes": "212.00% of Medicare Rates" } ] } ] }, { "description": "ORGANIC MENTAL HEALTH DISTURBANCES - SOI : 1", "code_information": [ { "code": "7571", "type": "APR-DRG" } ], "standard_charges": [ { "setting": "inpatient", "minimum": 5883.15, "maximum": 6471.47, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Better Health - Medi Medi", "methodology": "case rate", "standard_charge_dollar": 6471.47, "additional_payer_notes": "110% of State Medicaid Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Better Health Medicaid", "methodology": "case rate", "standard_charge_dollar": 6471.47, "additional_payer_notes": "110% of State Medicaid Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "case rate", "standard_charge_dollar": 5883.15, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "UBH", "plan_name": "UBH Medicaid", "methodology": "case rate", "standard_charge_dollar": 5883.15, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicaid (02/01/2023 to 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 6000.82, "additional_payer_notes": "102% of State Medicaid Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicaid", "methodology": "case rate", "standard_charge_dollar": 5883.15, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup Medicaid", "methodology": "case rate", "standard_charge_dollar": 5883.15, "additional_payer_notes": "100% of State Medicaid Rates" } ] } ] }, { "description": "Hc Thoracotomy With Exploration", "code_information": [ { "code": "32100", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 1700.0, "minimum": 324.53, "maximum": 1700.0, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 818.27, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC All Payer (02-01-2023 to 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 1700.0 }, { "payer_name": "UHC", "plan_name": "UHC Oxford (02-01-2023 to 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 1700.0 }, { "payer_name": "UHC - Adhoc", "plan_name": "UHC - Adhoc All Payer", "methodology": "case rate", "standard_charge_dollar": 1700.0 }, { "payer_name": "UHC - Adhoc", "plan_name": "UHC - Adhoc Oxford", "methodology": "case rate", "standard_charge_dollar": 1700.0 }, { "payer_name": "Wellchoice", "plan_name": "WELLCHOICE HMO of NJ (Empire) Commercial (HMO / HMO POS, PPO)", "methodology": "case rate", "standard_charge_dollar": 1700.0 }, { "payer_name": "Wellchoice", "plan_name": "WELLCHOICE HMO of NJ (Empire) Commercial (Indemnity)", "methodology": "case rate", "standard_charge_dollar": 1700.0 } ] } ] }, { "description": "BURNS WITH SKIN GRAFT EXCEPT EXTENSIVE 3RD DEGREE BURNS - SOI : 3", "code_information": [ { "code": "8423", "type": "APR-DRG" } ], "standard_charges": [ { "setting": "inpatient", "minimum": 43067.78, "maximum": 47374.56, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Better Health - Medi Medi", "methodology": "case rate", "standard_charge_dollar": 47374.56, "additional_payer_notes": "110% of State Medicaid Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Better Health Medicaid", "methodology": "case rate", "standard_charge_dollar": 47374.56, "additional_payer_notes": "110% of State Medicaid Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "case rate", "standard_charge_dollar": 43067.78, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "UBH", "plan_name": "UBH Medicaid", "methodology": "case rate", "standard_charge_dollar": 43067.78, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicaid (02/01/2023 to 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 43929.13, "additional_payer_notes": "102% of State Medicaid Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicaid", "methodology": "case rate", "standard_charge_dollar": 43067.78, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup Medicaid", "methodology": "case rate", "standard_charge_dollar": 43067.78, "additional_payer_notes": "100% of State Medicaid Rates" } ] } ] }, { "description": "FEMALE REPRODUCTIVE SYSTEM RECONSTRUCTIVE PROCEDURES", "code_information": [ { "code": "748", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 17589.0, "minimum": 8080.17, "maximum": 31836.1081, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "case rate", "standard_charge_dollar": 31836.11, "additional_payer_notes": "181.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medical Rental Network", "methodology": "case rate", "standard_charge_dollar": 31836.11, "additional_payer_notes": "181.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "case rate", "standard_charge_dollar": 14430.2, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "ALLY-ALIGN (FKA SPARTAN PLAN NJ, INC.)", "plan_name": "ALLY-ALIGN (FKA SPARTAN PLAN NJ, INC.)", "methodology": "case rate", "standard_charge_dollar": 18468.46, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Americhoice (UHC)", "plan_name": "UHC Medicare", "methodology": "case rate", "standard_charge_dollar": 14430.2, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Amerihealth", "plan_name": "Amerihealth Medicare", "methodology": "case rate", "standard_charge_dollar": 14430.2, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Commercial", "methodology": "case rate", "standard_charge_dollar": 20296.2 }, { "payer_name": "Clover Health", "plan_name": "Clover Medicare", "methodology": "case rate", "standard_charge_dollar": 14430.2, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Coventry", "plan_name": "Coventry Auto", "methodology": "case rate", "standard_charge_dollar": 29901.32, "additional_payer_notes": "170.00% of Medicare Rates" }, { "payer_name": "Coventry", "plan_name": "Coventry Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 29901.32, "additional_payer_notes": "170.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "case rate", "standard_charge_dollar": 22865.71, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Fairprice Healthcare Holdings", "plan_name": "Fairprice Healthcare Holdings", "methodology": "case rate", "standard_charge_dollar": 28142.42, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon Medicare", "methodology": "case rate", "standard_charge_dollar": 14430.2, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon NJ Health Medicaid", "methodology": "case rate", "standard_charge_dollar": 8080.17 }, { "payer_name": "Humana", "plan_name": "Humana Military Tricare", "methodology": "case rate", "standard_charge_dollar": 14071.21, "additional_payer_notes": "80.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 17589.01, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 25274.4 }, { "payer_name": "UBH", "plan_name": "UBH Medicare", "methodology": "case rate", "standard_charge_dollar": 14430.2, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC All Payer (02-01-2023 to 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 23384.33 }, { "payer_name": "UHC", "plan_name": "UHC Oxford (02-01-2023 to 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 20379.44 }, { "payer_name": "UHC - Adhoc", "plan_name": "UHC - Adhoc All Payer", "methodology": "case rate", "standard_charge_dollar": 24822.96 }, { "payer_name": "UHC - Adhoc", "plan_name": "UHC - Adhoc Oxford", "methodology": "case rate", "standard_charge_dollar": 21000.95 }, { "payer_name": "Wellcare", "plan_name": "Wellcare Insurance Exchange", "methodology": "case rate", "standard_charge_dollar": 23745.16, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "case rate", "standard_charge_dollar": 14430.2, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup Medicare", "methodology": "case rate", "standard_charge_dollar": 14430.2, "additional_payer_notes": "100.00% of Medicare Rates" } ] } ] }, { "description": "Hc Assay Of Serum Sodium", "code_information": [ { "code": "84295", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 43.0, "discounted_cash": 4.0, "minimum": 2.89, "maximum": 36.55, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 10.2, "additional_payer_notes": "212.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medical Rental Network", "methodology": "fee schedule", "standard_charge_dollar": 10.2, "additional_payer_notes": "212.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 4.81, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "ALLY-ALIGN (FKA SPARTAN PLAN NJ, INC.)", "plan_name": "ALLY-ALIGN (FKA SPARTAN PLAN NJ, INC.)", "methodology": "fee schedule", "standard_charge_dollar": 5.05, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Americhoice (UHC)", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 4.81, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Amerihealth", "plan_name": "Amerihealth Medicare", "methodology": "fee schedule", "standard_charge_dollar": 4.81, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 6.97, "additional_payer_notes": "Laboratory - 145.00% of Medicare Rates" }, { "payer_name": "Clover Health", "plan_name": "Clover Medicare", "methodology": "fee schedule", "standard_charge_dollar": 4.81, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Coventry", "plan_name": "Coventry Auto", "methodology": "fee schedule", "standard_charge_dollar": 9.62, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Coventry", "plan_name": "Coventry Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 9.62, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "fee schedule", "standard_charge_dollar": 6.73, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Fairprice Healthcare Holdings", "plan_name": "Fairprice Healthcare Holdings", "methodology": "fee schedule", "standard_charge_dollar": 5.77, "additional_payer_notes": "Laboratory - 120.00% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ HMO POS", "methodology": "fee schedule", "standard_charge_dollar": 30.36, "additional_payer_notes": "177.30% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ Indemnity", "methodology": "fee schedule", "standard_charge_dollar": 30.36, "additional_payer_notes": "177.30% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ PPO", "methodology": "fee schedule", "standard_charge_dollar": 30.36, "additional_payer_notes": "177.30% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon Medicare", "methodology": "fee schedule", "standard_charge_dollar": 4.81, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Military Tricare", "methodology": "fee schedule", "standard_charge_dollar": 3.85, "additional_payer_notes": "80.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 4.81, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 4.81, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC All Payer (02-01-2023 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 2.89 }, { "payer_name": "UHC", "plan_name": "UHC Medicaid (02/01/2023 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 3.85 }, { "payer_name": "UHC", "plan_name": "UHC Oxford (02-01-2023 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 2.89 }, { "payer_name": "UHC - Adhoc", "plan_name": "UHC - Adhoc All Payer", "methodology": "fee schedule", "standard_charge_dollar": 4.81 }, { "payer_name": "UHC - Adhoc", "plan_name": "UHC - Adhoc Oxford", "methodology": "fee schedule", "standard_charge_dollar": 4.81 }, { "payer_name": "Wellcare", "plan_name": "Wellcare Insurance Exchange", "methodology": "fee schedule", "standard_charge_dollar": 6.49, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 4.81, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup Medicare", "methodology": "fee schedule", "standard_charge_dollar": 4.81, "additional_payer_notes": "100.00% of Medicare Rates" } ] } ] }, { "description": "ANTEPARTUM WITH O.R. PROCEDURE- SOI : 2", "code_information": [ { "code": "5472", "type": "APR-DRG" } ], "standard_charges": [ { "setting": "inpatient", "minimum": 10671.85, "maximum": 11739.03, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Better Health - Medi Medi", "methodology": "case rate", "standard_charge_dollar": 11739.03, "additional_payer_notes": "110% of State Medicaid Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Better Health Medicaid", "methodology": "case rate", "standard_charge_dollar": 11739.03, "additional_payer_notes": "110% of State Medicaid Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "case rate", "standard_charge_dollar": 10671.85, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "UBH", "plan_name": "UBH Medicaid", "methodology": "case rate", "standard_charge_dollar": 10671.85, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicaid (02/01/2023 to 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 10885.28, "additional_payer_notes": "102% of State Medicaid Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicaid", "methodology": "case rate", "standard_charge_dollar": 10671.85, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup Medicaid", "methodology": "case rate", "standard_charge_dollar": 10671.85, "additional_payer_notes": "100% of State Medicaid Rates" } ] } ] }, { "description": "Exc Hip Pelvis Les Sc 3 Cm/>", "code_information": [ { "code": "27043", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 16672.5, "discounted_cash": 3433.0, "minimum": 1715.0, "maximum": 13338.0, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 7280.0, "additional_payer_notes": "212.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medical Rental Network", "methodology": "fee schedule", "standard_charge_dollar": 7280.0, "additional_payer_notes": "212.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3433.96, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "ALLY-ALIGN (FKA SPARTAN PLAN NJ, INC.)", "plan_name": "ALLY-ALIGN (FKA SPARTAN PLAN NJ, INC.)", "methodology": "fee schedule", "standard_charge_dollar": 3605.66, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Americhoice (UHC)", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3433.96, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Amerihealth", "plan_name": "Amerihealth Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3433.96, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 5046.2, "additional_payer_notes": "146.95% of Medicare Rates" }, { "payer_name": "Clover Health", "plan_name": "Clover Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3433.96, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Coventry", "plan_name": "Coventry Auto", "methodology": "fee schedule", "standard_charge_dollar": 6867.92, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Coventry", "plan_name": "Coventry Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 6867.92, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "fee schedule", "standard_charge_dollar": 4807.54, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Fairprice Healthcare Holdings", "plan_name": "Fairprice Healthcare Holdings", "methodology": "fee schedule", "standard_charge_dollar": 5494.34, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ HMO POS", "methodology": "fee schedule", "standard_charge_dollar": 6088.41, "additional_payer_notes": "177.30% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ Indemnity", "methodology": "fee schedule", "standard_charge_dollar": 6088.41, "additional_payer_notes": "177.30% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ PPO", "methodology": "fee schedule", "standard_charge_dollar": 6088.41, "additional_payer_notes": "177.30% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3433.96, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon NJ Health Medicaid", "methodology": "percent of total billed charges", "standard_charge_percentage": 19.58, "median_amount": 3766.7, "10th_percentile": 3766.7, "90th_percentile": 3766.7, "count": "1 through 10" }, { "payer_name": "Humana", "plan_name": "Humana Military Tricare", "methodology": "fee schedule", "standard_charge_dollar": 2747.17, "additional_payer_notes": "80.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3433.96, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 3433.96, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC All Payer (02-01-2023 to 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 4415.0 }, { "payer_name": "UHC", "plan_name": "UHC Oxford (02-01-2023 to 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 4020.0 }, { "payer_name": "UHC - Adhoc", "plan_name": "UHC - Adhoc All Payer", "methodology": "case rate", "standard_charge_dollar": 4687.0 }, { "payer_name": "UHC - Adhoc", "plan_name": "UHC - Adhoc Oxford", "methodology": "case rate", "standard_charge_dollar": 4143.0 }, { "payer_name": "Wellcare", "plan_name": "Wellcare Insurance Exchange", "methodology": "fee schedule", "standard_charge_dollar": 4635.85, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3433.96, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellchoice", "plan_name": "WELLCHOICE HMO of NJ (Empire) Commercial (HMO / HMO POS, PPO)", "methodology": "case rate", "standard_charge_dollar": 1715.0 }, { "payer_name": "Wellchoice", "plan_name": "WELLCHOICE HMO of NJ (Empire) Commercial (Indemnity)", "methodology": "case rate", "standard_charge_dollar": 1978.0 }, { "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3433.96, "additional_payer_notes": "100.00% of Medicare Rates" } ] } ] }, { "description": "MALNUTRITION, FAILURE TO THRIVE & OTHER NUTRITIONAL DISORDERS - SOI : 1", "code_information": [ { "code": "4211", "type": "APR-DRG" } ], "standard_charges": [ { "setting": "inpatient", "minimum": 5059.44, "maximum": 5565.38, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Better Health - Medi Medi", "methodology": "case rate", "standard_charge_dollar": 5565.38, "additional_payer_notes": "110% of State Medicaid Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Better Health Medicaid", "methodology": "case rate", "standard_charge_dollar": 5565.38, "additional_payer_notes": "110% of State Medicaid Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "case rate", "standard_charge_dollar": 5059.44, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "UBH", "plan_name": "UBH Medicaid", "methodology": "case rate", "standard_charge_dollar": 5059.44, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicaid (02/01/2023 to 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 5160.62, "additional_payer_notes": "102% of State Medicaid Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicaid", "methodology": "case rate", "standard_charge_dollar": 5059.44, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup Medicaid", "methodology": "case rate", "standard_charge_dollar": 5059.44, "additional_payer_notes": "100% of State Medicaid Rates" } ] } ] }, { "description": "Hc Contrast Inj Perq Radiologic Eval Gi Tube", "code_information": [ { "code": "49465", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 1208.6, "discounted_cash": 282.0, "minimum": 225.656, "maximum": 1208.6, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 597.99, "additional_payer_notes": "212.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medical Rental Network", "methodology": "fee schedule", "standard_charge_dollar": 597.99, "additional_payer_notes": "212.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 282.07, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "ALLY-ALIGN (FKA SPARTAN PLAN NJ, INC.)", "plan_name": "ALLY-ALIGN (FKA SPARTAN PLAN NJ, INC.)", "methodology": "fee schedule", "standard_charge_dollar": 296.17, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Americhoice (UHC)", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 282.07, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Amerihealth", "plan_name": "Amerihealth Medicare", "methodology": "fee schedule", "standard_charge_dollar": 282.07, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 414.5, "additional_payer_notes": "146.95% of Medicare Rates" }, { "payer_name": "Clover Health", "plan_name": "Clover Medicare", "methodology": "fee schedule", "standard_charge_dollar": 282.07, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Coventry", "plan_name": "Coventry Auto", "methodology": "fee schedule", "standard_charge_dollar": 564.14, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Coventry", "plan_name": "Coventry Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 564.14, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "fee schedule", "standard_charge_dollar": 394.9, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Fairprice Healthcare Holdings", "plan_name": "Fairprice Healthcare Holdings", "methodology": "fee schedule", "standard_charge_dollar": 451.31, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ HMO POS", "methodology": "fee schedule", "standard_charge_dollar": 500.11, "additional_payer_notes": "177.30% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ Indemnity", "methodology": "fee schedule", "standard_charge_dollar": 500.11, "additional_payer_notes": "177.30% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ PPO", "methodology": "fee schedule", "standard_charge_dollar": 500.11, "additional_payer_notes": "177.30% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon Medicare", "methodology": "fee schedule", "standard_charge_dollar": 282.07, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Military Tricare", "methodology": "fee schedule", "standard_charge_dollar": 225.66, "additional_payer_notes": "80.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 282.07, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 282.07, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC All Payer (02-01-2023 to 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 1208.6 }, { "payer_name": "UHC", "plan_name": "UHC Oxford (02-01-2023 to 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 1208.6 }, { "payer_name": "UHC - Adhoc", "plan_name": "UHC - Adhoc All Payer", "methodology": "case rate", "standard_charge_dollar": 1208.6 }, { "payer_name": "UHC - Adhoc", "plan_name": "UHC - Adhoc Oxford", "methodology": "case rate", "standard_charge_dollar": 1208.6 }, { "payer_name": "Wellcare", "plan_name": "Wellcare Insurance Exchange", "methodology": "fee schedule", "standard_charge_dollar": 380.79, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 282.07, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup Medicare", "methodology": "fee schedule", "standard_charge_dollar": 282.07, "additional_payer_notes": "100.00% of Medicare Rates" } ] } ] }, { "description": "Hc Reticulocyte Count, Auto", "code_information": [ { "code": "85045", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 84.0, "discounted_cash": 3.0, "minimum": 2.39, "maximum": 71.4, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 8.46, "additional_payer_notes": "212.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medical Rental Network", "methodology": "fee schedule", "standard_charge_dollar": 8.46, "additional_payer_notes": "212.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3.99, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "ALLY-ALIGN (FKA SPARTAN PLAN NJ, INC.)", "plan_name": "ALLY-ALIGN (FKA SPARTAN PLAN NJ, INC.)", "methodology": "fee schedule", "standard_charge_dollar": 4.19, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Americhoice (UHC)", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3.99, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Amerihealth", "plan_name": "Amerihealth Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3.99, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 5.79, "additional_payer_notes": "Laboratory - 145.00% of Medicare Rates" }, { "payer_name": "Clover Health", "plan_name": "Clover Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3.99, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Coventry", "plan_name": "Coventry Auto", "methodology": "fee schedule", "standard_charge_dollar": 7.98, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Coventry", "plan_name": "Coventry Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 7.98, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "fee schedule", "standard_charge_dollar": 5.59, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Fairprice Healthcare Holdings", "plan_name": "Fairprice Healthcare Holdings", "methodology": "fee schedule", "standard_charge_dollar": 4.79, "additional_payer_notes": "Laboratory - 120.00% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ HMO POS", "methodology": "fee schedule", "standard_charge_dollar": 59.3, "additional_payer_notes": "177.30% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ Indemnity", "methodology": "fee schedule", "standard_charge_dollar": 59.3, "additional_payer_notes": "177.30% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ PPO", "methodology": "fee schedule", "standard_charge_dollar": 59.3, "additional_payer_notes": "177.30% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3.99, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Military Tricare", "methodology": "fee schedule", "standard_charge_dollar": 3.19, "additional_payer_notes": "80.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3.99, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 3.99, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC All Payer (02-01-2023 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 2.39 }, { "payer_name": "UHC", "plan_name": "UHC Medicaid (02/01/2023 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 3.19 }, { "payer_name": "UHC", "plan_name": "UHC Oxford (02-01-2023 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 2.39 }, { "payer_name": "UHC - Adhoc", "plan_name": "UHC - Adhoc All Payer", "methodology": "fee schedule", "standard_charge_dollar": 3.99 }, { "payer_name": "UHC - Adhoc", "plan_name": "UHC - Adhoc Oxford", "methodology": "fee schedule", "standard_charge_dollar": 3.99 }, { "payer_name": "Wellcare", "plan_name": "Wellcare Insurance Exchange", "methodology": "fee schedule", "standard_charge_dollar": 5.39, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3.99, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup Medicaid", "methodology": "percent of total billed charges", "standard_charge_percentage": 19.09, "median_amount": 15.67, "10th_percentile": 12.6, "90th_percentile": 15.67, "count": "1 through 10" }, { "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3.99, "additional_payer_notes": "100.00% of Medicare Rates" } ] } ] }, { "description": "INSERTION, REVISION AND REPLACEMENTS OF PACEMAKER AND OTHER CARDIAC DEVICES- SOI : 2", "code_information": [ { "code": "1762", "type": "APR-DRG" } ], "standard_charges": [ { "setting": "inpatient", "minimum": 24875.7, "maximum": 27363.27, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Better Health - Medi Medi", "methodology": "case rate", "standard_charge_dollar": 27363.27, "additional_payer_notes": "110% of State Medicaid Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Better Health Medicaid", "methodology": "case rate", "standard_charge_dollar": 27363.27, "additional_payer_notes": "110% of State Medicaid Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "case rate", "standard_charge_dollar": 24875.7, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "UBH", "plan_name": "UBH Medicaid", "methodology": "case rate", "standard_charge_dollar": 24875.7, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicaid (02/01/2023 to 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 25373.21, "additional_payer_notes": "102% of State Medicaid Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicaid", "methodology": "case rate", "standard_charge_dollar": 24875.7, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup Medicaid", "methodology": "case rate", "standard_charge_dollar": 24875.7, "additional_payer_notes": "100% of State Medicaid Rates" } ] } ] }, { "description": "Hc Assay Quantitative,Blood Glucose", "code_information": [ { "code": "82947", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 100.0, "discounted_cash": 3.0, "minimum": 2.36, "maximum": 85.0, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 8.33, "additional_payer_notes": "212.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medical Rental Network", "methodology": "fee schedule", "standard_charge_dollar": 8.33, "additional_payer_notes": "212.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3.93, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "ALLY-ALIGN (FKA SPARTAN PLAN NJ, INC.)", "plan_name": "ALLY-ALIGN (FKA SPARTAN PLAN NJ, INC.)", "methodology": "fee schedule", "standard_charge_dollar": 4.13, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Americhoice (UHC)", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3.93, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Amerihealth", "plan_name": "Amerihealth HMO", "methodology": "percent of total billed charges", "standard_charge_percentage": 50.0, "median_amount": 3.14, "10th_percentile": 3.14, "90th_percentile": 50.0, "count": "1 through 10" }, { "payer_name": "Amerihealth", "plan_name": "Amerihealth Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3.93, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 5.7, "additional_payer_notes": "A Indicator - 155.00% of Medicare Rates" }, { "payer_name": "Clover Health", "plan_name": "Clover Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3.93, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Coventry", "plan_name": "Coventry Auto", "methodology": "fee schedule", "standard_charge_dollar": 7.86, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Coventry", "plan_name": "Coventry Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 7.86, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "fee schedule", "standard_charge_dollar": 5.5, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Fairprice Healthcare Holdings", "plan_name": "Fairprice Healthcare Holdings", "methodology": "fee schedule", "standard_charge_dollar": 4.72, "additional_payer_notes": "Laboratory - 120.00% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ HMO POS", "methodology": "fee schedule", "standard_charge_dollar": 70.6, "additional_payer_notes": "177.30% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ Indemnity", "methodology": "fee schedule", "standard_charge_dollar": 70.6, "additional_payer_notes": "177.30% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ PPO", "methodology": "fee schedule", "standard_charge_dollar": 70.6, "additional_payer_notes": "177.30% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3.93, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Military Tricare", "methodology": "fee schedule", "standard_charge_dollar": 3.14, "additional_payer_notes": "80.00% of Medicare Rates" }, { "payer_name": "Keenan", "plan_name": "Keenan", "methodology": "percent of total billed charges", "standard_charge_percentage": 30.0, "median_amount": 117.9, "10th_percentile": 30.0, "90th_percentile": 245.5, "count": "1 through 10" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3.93, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 3.93, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC All Payer (02-01-2023 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 2.36 }, { "payer_name": "UHC", "plan_name": "UHC Medicaid (02/01/2023 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 3.14 }, { "payer_name": "UHC", "plan_name": "UHC Oxford (02-01-2023 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 2.36 }, { "payer_name": "UHC - Adhoc", "plan_name": "UHC - Adhoc All Payer", "methodology": "fee schedule", "standard_charge_dollar": 3.93 }, { "payer_name": "UHC - Adhoc", "plan_name": "UHC - Adhoc Oxford", "methodology": "fee schedule", "standard_charge_dollar": 3.93 }, { "payer_name": "Wellcare", "plan_name": "Wellcare Insurance Exchange", "methodology": "fee schedule", "standard_charge_dollar": 5.31, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3.93, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup Medicaid", "methodology": "percent of total billed charges", "standard_charge_percentage": 19.09, "median_amount": 4.0, "10th_percentile": 4.0, "90th_percentile": 4.0, "count": "1 through 10" }, { "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3.93, "additional_payer_notes": "100.00% of Medicare Rates" } ] } ] }, { "description": "Hc Glycosylated Hemoglobin Test", "code_information": [ { "code": "83036", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 90.0, "discounted_cash": 9.0, "minimum": 5.83, "maximum": 76.5, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 20.59, "additional_payer_notes": "212.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medical Rental Network", "methodology": "fee schedule", "standard_charge_dollar": 20.59, "additional_payer_notes": "212.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 9.71, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "ALLY-ALIGN (FKA SPARTAN PLAN NJ, INC.)", "plan_name": "ALLY-ALIGN (FKA SPARTAN PLAN NJ, INC.)", "methodology": "fee schedule", "standard_charge_dollar": 10.2, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Americhoice (UHC)", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 9.71, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Amerihealth", "plan_name": "Amerihealth Medicare", "methodology": "fee schedule", "standard_charge_dollar": 9.71, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 14.08, "additional_payer_notes": "Laboratory - 145.00% of Medicare Rates" }, { "payer_name": "Clover Health", "plan_name": "Clover Medicare", "methodology": "fee schedule", "standard_charge_dollar": 9.71, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Coventry", "plan_name": "Coventry Auto", "methodology": "fee schedule", "standard_charge_dollar": 19.42, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Coventry", "plan_name": "Coventry Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 19.42, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "fee schedule", "standard_charge_dollar": 13.59, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Fairprice Healthcare Holdings", "plan_name": "Fairprice Healthcare Holdings", "methodology": "fee schedule", "standard_charge_dollar": 11.65, "additional_payer_notes": "Laboratory - 120.00% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ HMO POS", "methodology": "fee schedule", "standard_charge_dollar": 63.54, "additional_payer_notes": "177.30% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ Indemnity", "methodology": "fee schedule", "standard_charge_dollar": 63.54, "additional_payer_notes": "177.30% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ PPO", "methodology": "fee schedule", "standard_charge_dollar": 63.54, "additional_payer_notes": "177.30% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon Medicare", "methodology": "fee schedule", "standard_charge_dollar": 9.71, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Military Tricare", "methodology": "fee schedule", "standard_charge_dollar": 7.77, "additional_payer_notes": "80.00% of Medicare Rates" }, { "payer_name": "Keenan", "plan_name": "Keenan", "methodology": "percent of total billed charges", "standard_charge_percentage": 30.0, "median_amount": 27.0, "10th_percentile": 27.0, "90th_percentile": 27.0, "count": "1 through 10" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 9.71, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 9.71, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC All Payer (02-01-2023 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 5.83 }, { "payer_name": "UHC", "plan_name": "UHC Medicaid (02/01/2023 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 7.77 }, { "payer_name": "UHC", "plan_name": "UHC Oxford (02-01-2023 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 5.83 }, { "payer_name": "UHC - Adhoc", "plan_name": "UHC - Adhoc All Payer", "methodology": "fee schedule", "standard_charge_dollar": 9.71 }, { "payer_name": "UHC - Adhoc", "plan_name": "UHC - Adhoc Oxford", "methodology": "fee schedule", "standard_charge_dollar": 9.71 }, { "payer_name": "Wellcare", "plan_name": "Wellcare Insurance Exchange", "methodology": "fee schedule", "standard_charge_dollar": 13.11, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 9.71, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup Medicaid", "methodology": "percent of total billed charges", "standard_charge_percentage": 19.09, "median_amount": 16.79, "10th_percentile": 9.71, "90th_percentile": 16.79, "count": "15" }, { "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup Medicare", "methodology": "fee schedule", "standard_charge_dollar": 9.71, "additional_payer_notes": "100.00% of Medicare Rates" } ] } ] }, { "description": "Hc Transferase Aspartate Amino (Ast) (Sgot)", "code_information": [ { "code": "84450", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 100.0, "discounted_cash": 5.0, "minimum": 3.11, "maximum": 85.0, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 10.98, "additional_payer_notes": "212.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medical Rental Network", "methodology": "fee schedule", "standard_charge_dollar": 10.98, "additional_payer_notes": "212.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5.18, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "ALLY-ALIGN (FKA SPARTAN PLAN NJ, INC.)", "plan_name": "ALLY-ALIGN (FKA SPARTAN PLAN NJ, INC.)", "methodology": "fee schedule", "standard_charge_dollar": 5.44, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Americhoice (UHC)", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5.18, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Amerihealth", "plan_name": "Amerihealth Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5.18, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 7.51, "additional_payer_notes": "Laboratory - 145.00% of Medicare Rates" }, { "payer_name": "Clover Health", "plan_name": "Clover Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5.18, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Coventry", "plan_name": "Coventry Auto", "methodology": "fee schedule", "standard_charge_dollar": 10.36, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Coventry", "plan_name": "Coventry Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 10.36, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "fee schedule", "standard_charge_dollar": 7.25, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Fairprice Healthcare Holdings", "plan_name": "Fairprice Healthcare Holdings", "methodology": "fee schedule", "standard_charge_dollar": 6.22, "additional_payer_notes": "Laboratory - 120.00% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ HMO POS", "methodology": "fee schedule", "standard_charge_dollar": 70.6, "additional_payer_notes": "177.30% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ Indemnity", "methodology": "fee schedule", "standard_charge_dollar": 70.6, "additional_payer_notes": "177.30% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ PPO", "methodology": "fee schedule", "standard_charge_dollar": 70.6, "additional_payer_notes": "177.30% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5.18, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Military Tricare", "methodology": "fee schedule", "standard_charge_dollar": 4.14, "additional_payer_notes": "80.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5.18, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 5.18, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC All Payer (02-01-2023 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 3.11 }, { "payer_name": "UHC", "plan_name": "UHC Medicaid (02/01/2023 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 4.14 }, { "payer_name": "UHC", "plan_name": "UHC Oxford (02-01-2023 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 3.11 }, { "payer_name": "UHC - Adhoc", "plan_name": "UHC - Adhoc All Payer", "methodology": "fee schedule", "standard_charge_dollar": 5.18 }, { "payer_name": "UHC - Adhoc", "plan_name": "UHC - Adhoc Oxford", "methodology": "fee schedule", "standard_charge_dollar": 5.18 }, { "payer_name": "Wellcare", "plan_name": "Wellcare Insurance Exchange", "methodology": "fee schedule", "standard_charge_dollar": 6.99, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5.18, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5.18, "additional_payer_notes": "100.00% of Medicare Rates" } ] } ] }, { "description": "OTHER DISORDERS OF THE LIVER - SOI : 4", "code_information": [ { "code": "2834", "type": "APR-DRG" } ], "standard_charges": [ { "setting": "inpatient", "minimum": 21798.78, "maximum": 23978.66, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Better Health - Medi Medi", "methodology": "case rate", "standard_charge_dollar": 23978.66, "additional_payer_notes": "110% of State Medicaid Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Better Health Medicaid", "methodology": "case rate", "standard_charge_dollar": 23978.66, "additional_payer_notes": "110% of State Medicaid Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "case rate", "standard_charge_dollar": 21798.78, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "UBH", "plan_name": "UBH Medicaid", "methodology": "case rate", "standard_charge_dollar": 21798.78, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicaid (02/01/2023 to 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 22234.76, "additional_payer_notes": "102% of State Medicaid Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicaid", "methodology": "case rate", "standard_charge_dollar": 21798.78, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup Medicaid", "methodology": "case rate", "standard_charge_dollar": 21798.78, "additional_payer_notes": "100% of State Medicaid Rates" } ] } ] }, { "description": "Hc Cytopath C/V Index Add-On", "code_information": [ { "code": "88155", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 43.0, "discounted_cash": 14.0, "minimum": 8.2087, "maximum": 36.55, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 31.06, "additional_payer_notes": "212.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medical Rental Network", "methodology": "fee schedule", "standard_charge_dollar": 31.06, "additional_payer_notes": "212.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 14.65, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "ALLY-ALIGN (FKA SPARTAN PLAN NJ, INC.)", "plan_name": "ALLY-ALIGN (FKA SPARTAN PLAN NJ, INC.)", "methodology": "fee schedule", "standard_charge_dollar": 15.38, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Americhoice (UHC)", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 14.65, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Amerihealth", "plan_name": "Amerihealth Medicare", "methodology": "fee schedule", "standard_charge_dollar": 14.65, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 21.24, "additional_payer_notes": "Laboratory - 145.00% of Medicare Rates" }, { "payer_name": "Clover Health", "plan_name": "Clover Medicare", "methodology": "fee schedule", "standard_charge_dollar": 14.65, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Coventry", "plan_name": "Coventry Auto", "methodology": "fee schedule", "standard_charge_dollar": 29.3, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Coventry", "plan_name": "Coventry Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 29.3, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "fee schedule", "standard_charge_dollar": 20.51, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Fairprice Healthcare Holdings", "plan_name": "Fairprice Healthcare Holdings", "methodology": "fee schedule", "standard_charge_dollar": 17.58, "additional_payer_notes": "Laboratory - 120.00% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ HMO POS", "methodology": "fee schedule", "standard_charge_dollar": 30.36, "additional_payer_notes": "177.30% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ Indemnity", "methodology": "fee schedule", "standard_charge_dollar": 30.36, "additional_payer_notes": "177.30% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ PPO", "methodology": "fee schedule", "standard_charge_dollar": 30.36, "additional_payer_notes": "177.30% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon Medicare", "methodology": "fee schedule", "standard_charge_dollar": 14.65, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon NJ Health Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 11.72 }, { "payer_name": "Humana", "plan_name": "Humana Military Tricare", "methodology": "fee schedule", "standard_charge_dollar": 11.72, "additional_payer_notes": "80.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 14.65, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 14.65, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC All Payer (02-01-2023 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 8.79 }, { "payer_name": "UHC", "plan_name": "UHC Medicaid (02/01/2023 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 11.72 }, { "payer_name": "UHC", "plan_name": "UHC Oxford (02-01-2023 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 8.79 }, { "payer_name": "UHC - Adhoc", "plan_name": "UHC - Adhoc All Payer", "methodology": "fee schedule", "standard_charge_dollar": 14.65 }, { "payer_name": "UHC - Adhoc", "plan_name": "UHC - Adhoc Oxford", "methodology": "fee schedule", "standard_charge_dollar": 14.65 }, { "payer_name": "Wellcare", "plan_name": "Wellcare Insurance Exchange", "methodology": "fee schedule", "standard_charge_dollar": 19.78, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 14.65, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup Medicare", "methodology": "fee schedule", "standard_charge_dollar": 14.65, "additional_payer_notes": "100.00% of Medicare Rates" } ] } ] }, { "description": "OTHER O.R. PROCEDURES OF THE BLOOD AND BLOOD FORMING ORGANS WITH MCC", "code_information": [ { "code": "802", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 47598.0, "minimum": 20901.04, "maximum": 86153.9185, "payers_information": [ { "payer_name": "Coventry", "plan_name": "Coventry Auto", "methodology": "case rate", "standard_charge_dollar": 80918.05, "additional_payer_notes": "170.00% of Medicare Rates" }, { "payer_name": "Coventry", "plan_name": "Coventry Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 80918.05, "additional_payer_notes": "170.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "case rate", "standard_charge_dollar": 61878.51, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Fairprice Healthcare Holdings", "plan_name": "Fairprice Healthcare Holdings", "methodology": "case rate", "standard_charge_dollar": 76158.16, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon Medicare", "methodology": "case rate", "standard_charge_dollar": 38527.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon NJ Health Medicaid", "methodology": "case rate", "standard_charge_dollar": 20901.04 }, { "payer_name": "Humana", "plan_name": "Humana Military Tricare", "methodology": "case rate", "standard_charge_dollar": 38079.08, "additional_payer_notes": "80.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 47598.85, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 52154.5 }, { "payer_name": "UBH", "plan_name": "UBH Medicare", "methodology": "case rate", "standard_charge_dollar": 38527.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC All Payer (02-01-2023 to 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 67155.99 }, { "payer_name": "UHC", "plan_name": "UHC Oxford (02-01-2023 to 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 58526.43 }, { "payer_name": "UHC - Adhoc", "plan_name": "UHC - Adhoc All Payer", "methodology": "case rate", "standard_charge_dollar": 71287.5 }, { "payer_name": "UHC - Adhoc", "plan_name": "UHC - Adhoc Oxford", "methodology": "case rate", "standard_charge_dollar": 60311.31 }, { "payer_name": "Wellcare", "plan_name": "Wellcare Insurance Exchange", "methodology": "case rate", "standard_charge_dollar": 64258.45, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "case rate", "standard_charge_dollar": 38527.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup Medicare", "methodology": "case rate", "standard_charge_dollar": 38527.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "case rate", "standard_charge_dollar": 86153.92, "additional_payer_notes": "181.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medical Rental Network", "methodology": "case rate", "standard_charge_dollar": 86153.92, "additional_payer_notes": "181.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "case rate", "standard_charge_dollar": 38527.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "ALLY-ALIGN (FKA SPARTAN PLAN NJ, INC.)", "plan_name": "ALLY-ALIGN (FKA SPARTAN PLAN NJ, INC.)", "methodology": "case rate", "standard_charge_dollar": 49978.79, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Americhoice (UHC)", "plan_name": "UHC Medicare", "methodology": "case rate", "standard_charge_dollar": 38527.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Amerihealth", "plan_name": "Amerihealth Medicare", "methodology": "case rate", "standard_charge_dollar": 38527.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Commercial", "methodology": "case rate", "standard_charge_dollar": 58287.38 }, { "payer_name": "Clover Health", "plan_name": "Clover Medicare", "methodology": "case rate", "standard_charge_dollar": 38527.3, "additional_payer_notes": "100.00% of Medicare Rates" } ] } ] }, { "description": "Hc Trim Nail(S)", "code_information": [ { "code": "11719", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 251.09, "discounted_cash": 69.0, "minimum": 47.9331, "maximum": 251.09, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 147.85, "additional_payer_notes": "212.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medical Rental Network", "methodology": "fee schedule", "standard_charge_dollar": 147.85, "additional_payer_notes": "212.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 69.74, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "ALLY-ALIGN (FKA SPARTAN PLAN NJ, INC.)", "plan_name": "ALLY-ALIGN (FKA SPARTAN PLAN NJ, INC.)", "methodology": "fee schedule", "standard_charge_dollar": 73.23, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Americhoice (UHC)", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 69.74, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Amerihealth", "plan_name": "Amerihealth Medicare", "methodology": "fee schedule", "standard_charge_dollar": 69.74, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 102.48, "additional_payer_notes": "146.95% of Medicare Rates" }, { "payer_name": "Clover Health", "plan_name": "Clover Medicare", "methodology": "fee schedule", "standard_charge_dollar": 69.74, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Coventry", "plan_name": "Coventry Auto", "methodology": "fee schedule", "standard_charge_dollar": 139.48, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Coventry", "plan_name": "Coventry Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 139.48, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "fee schedule", "standard_charge_dollar": 97.64, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Fairprice Healthcare Holdings", "plan_name": "Fairprice Healthcare Holdings", "methodology": "fee schedule", "standard_charge_dollar": 111.58, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ HMO POS", "methodology": "fee schedule", "standard_charge_dollar": 123.65, "additional_payer_notes": "177.30% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ Indemnity", "methodology": "fee schedule", "standard_charge_dollar": 123.65, "additional_payer_notes": "177.30% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ PPO", "methodology": "fee schedule", "standard_charge_dollar": 123.65, "additional_payer_notes": "177.30% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon Medicare", "methodology": "fee schedule", "standard_charge_dollar": 69.74, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Military Tricare", "methodology": "fee schedule", "standard_charge_dollar": 55.79, "additional_payer_notes": "80.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 69.74, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 69.74, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC All Payer (02-01-2023 to 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 251.09 }, { "payer_name": "UHC", "plan_name": "UHC Oxford (02-01-2023 to 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 251.09 }, { "payer_name": "UHC - Adhoc", "plan_name": "UHC - Adhoc All Payer", "methodology": "case rate", "standard_charge_dollar": 251.09 }, { "payer_name": "UHC - Adhoc", "plan_name": "UHC - Adhoc Oxford", "methodology": "case rate", "standard_charge_dollar": 251.09 }, { "payer_name": "Wellcare", "plan_name": "Wellcare Insurance Exchange", "methodology": "fee schedule", "standard_charge_dollar": 94.15, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 69.74, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup Medicare", "methodology": "fee schedule", "standard_charge_dollar": 69.74, "additional_payer_notes": "100.00% of Medicare Rates" } ] } ] }, { "description": "INBORN ERRORS OF METABOLISM - SOI : 1", "code_information": [ { "code": "4231", "type": "APR-DRG" } ], "standard_charges": [ { "setting": "inpatient", "minimum": 6661.7, "maximum": 7327.87, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Better Health - Medi Medi", "methodology": "case rate", "standard_charge_dollar": 7327.87, "additional_payer_notes": "110% of State Medicaid Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Better Health Medicaid", "methodology": "case rate", "standard_charge_dollar": 7327.87, "additional_payer_notes": "110% of State Medicaid Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "case rate", "standard_charge_dollar": 6661.7, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "UBH", "plan_name": "UBH Medicaid", "methodology": "case rate", "standard_charge_dollar": 6661.7, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicaid (02/01/2023 to 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 6794.94, "additional_payer_notes": "102% of State Medicaid Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicaid", "methodology": "case rate", "standard_charge_dollar": 6661.7, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup Medicaid", "methodology": "case rate", "standard_charge_dollar": 6661.7, "additional_payer_notes": "100% of State Medicaid Rates" } ] } ] }, { "description": "Hc Unlisted Noninvasive Vascular Diagnostic Study", "code_information": [ { "code": "93998", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 114.95, "discounted_cash": 34.0, "minimum": 21.944, "maximum": 114.95, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 72.48, "additional_payer_notes": "212.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medical Rental Network", "methodology": "fee schedule", "standard_charge_dollar": 72.48, "additional_payer_notes": "212.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 34.19, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "ALLY-ALIGN (FKA SPARTAN PLAN NJ, INC.)", "plan_name": "ALLY-ALIGN (FKA SPARTAN PLAN NJ, INC.)", "methodology": "fee schedule", "standard_charge_dollar": 35.9, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Americhoice (UHC)", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 34.19, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Amerihealth", "plan_name": "Amerihealth Medicare", "methodology": "fee schedule", "standard_charge_dollar": 34.19, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 50.24, "additional_payer_notes": "146.95% of Medicare Rates" }, { "payer_name": "Clover Health", "plan_name": "Clover Medicare", "methodology": "fee schedule", "standard_charge_dollar": 34.19, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Coventry", "plan_name": "Coventry Auto", "methodology": "fee schedule", "standard_charge_dollar": 68.38, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Coventry", "plan_name": "Coventry Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 68.38, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "fee schedule", "standard_charge_dollar": 47.87, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Fairprice Healthcare Holdings", "plan_name": "Fairprice Healthcare Holdings", "methodology": "fee schedule", "standard_charge_dollar": 54.7, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ HMO POS", "methodology": "fee schedule", "standard_charge_dollar": 60.62, "additional_payer_notes": "177.30% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ Indemnity", "methodology": "fee schedule", "standard_charge_dollar": 60.62, "additional_payer_notes": "177.30% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ PPO", "methodology": "fee schedule", "standard_charge_dollar": 60.62, "additional_payer_notes": "177.30% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon Medicare", "methodology": "fee schedule", "standard_charge_dollar": 34.19, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Military Tricare", "methodology": "fee schedule", "standard_charge_dollar": 27.35, "additional_payer_notes": "80.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 34.19, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 34.19, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC All Payer (02-01-2023 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 114.95 }, { "payer_name": "UHC", "plan_name": "UHC Oxford (02-01-2023 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 114.95 }, { "payer_name": "UHC - Adhoc", "plan_name": "UHC - Adhoc All Payer", "methodology": "fee schedule", "standard_charge_dollar": 114.95 }, { "payer_name": "UHC - Adhoc", "plan_name": "UHC - Adhoc Oxford", "methodology": "fee schedule", "standard_charge_dollar": 114.95 }, { "payer_name": "Wellcare", "plan_name": "Wellcare Insurance Exchange", "methodology": "fee schedule", "standard_charge_dollar": 46.16, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 34.19, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup Medicare", "methodology": "fee schedule", "standard_charge_dollar": 34.19, "additional_payer_notes": "100.00% of Medicare Rates" } ] } ] }, { "description": "Hc Intrinsic Factor Antibody", "code_information": [ { "code": "86340", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 53.53, "discounted_cash": 15.0, "minimum": 9.05, "maximum": 45.5005, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 31.97, "additional_payer_notes": "212.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medical Rental Network", "methodology": "fee schedule", "standard_charge_dollar": 31.97, "additional_payer_notes": "212.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 15.08, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "ALLY-ALIGN (FKA SPARTAN PLAN NJ, INC.)", "plan_name": "ALLY-ALIGN (FKA SPARTAN PLAN NJ, INC.)", "methodology": "fee schedule", "standard_charge_dollar": 15.83, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Americhoice (UHC)", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 15.08, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Amerihealth", "plan_name": "Amerihealth Medicare", "methodology": "fee schedule", "standard_charge_dollar": 15.08, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 21.87, "additional_payer_notes": "Laboratory - 145.00% of Medicare Rates" }, { "payer_name": "Clover Health", "plan_name": "Clover Medicare", "methodology": "fee schedule", "standard_charge_dollar": 15.08, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Coventry", "plan_name": "Coventry Auto", "methodology": "fee schedule", "standard_charge_dollar": 30.16, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Coventry", "plan_name": "Coventry Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 30.16, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "fee schedule", "standard_charge_dollar": 21.11, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Fairprice Healthcare Holdings", "plan_name": "Fairprice Healthcare Holdings", "methodology": "fee schedule", "standard_charge_dollar": 18.1, "additional_payer_notes": "Laboratory - 120.00% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ HMO POS", "methodology": "fee schedule", "standard_charge_dollar": 37.79, "additional_payer_notes": "177.30% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ Indemnity", "methodology": "fee schedule", "standard_charge_dollar": 37.79, "additional_payer_notes": "177.30% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ PPO", "methodology": "fee schedule", "standard_charge_dollar": 37.79, "additional_payer_notes": "177.30% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon Medicare", "methodology": "fee schedule", "standard_charge_dollar": 15.08, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Military Tricare", "methodology": "fee schedule", "standard_charge_dollar": 12.06, "additional_payer_notes": "80.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 15.08, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 15.08, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC All Payer (02-01-2023 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 9.05 }, { "payer_name": "UHC", "plan_name": "UHC Medicaid (02/01/2023 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 12.06 }, { "payer_name": "UHC", "plan_name": "UHC Oxford (02-01-2023 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 9.05 }, { "payer_name": "UHC - Adhoc", "plan_name": "UHC - Adhoc All Payer", "methodology": "fee schedule", "standard_charge_dollar": 15.08 }, { "payer_name": "UHC - Adhoc", "plan_name": "UHC - Adhoc Oxford", "methodology": "fee schedule", "standard_charge_dollar": 15.08 }, { "payer_name": "Wellcare", "plan_name": "Wellcare Insurance Exchange", "methodology": "fee schedule", "standard_charge_dollar": 20.36, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 15.08, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup Medicare", "methodology": "fee schedule", "standard_charge_dollar": 15.08, "additional_payer_notes": "100.00% of Medicare Rates" } ] } ] }, { "description": "Hc Angio Aortogram Thoracic", "code_information": [ { "code": "75600", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 13207.6, "discounted_cash": 3732.0, "minimum": 2521.3308, "maximum": 11226.46, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 7913.51, "additional_payer_notes": "212.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medical Rental Network", "methodology": "fee schedule", "standard_charge_dollar": 7913.51, "additional_payer_notes": "212.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3732.79, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "ALLY-ALIGN (FKA SPARTAN PLAN NJ, INC.)", "plan_name": "ALLY-ALIGN (FKA SPARTAN PLAN NJ, INC.)", "methodology": "fee schedule", "standard_charge_dollar": 3919.43, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Americhoice (UHC)", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3732.79, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Amerihealth", "plan_name": "Amerihealth Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3732.79, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 5485.33, "additional_payer_notes": "146.95% of Medicare Rates" }, { "payer_name": "Clover Health", "plan_name": "Clover Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3732.79, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Coventry", "plan_name": "Coventry Auto", "methodology": "fee schedule", "standard_charge_dollar": 7465.58, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Coventry", "plan_name": "Coventry Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 7465.58, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "fee schedule", "standard_charge_dollar": 5225.91, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Fairprice Healthcare Holdings", "plan_name": "Fairprice Healthcare Holdings", "methodology": "fee schedule", "standard_charge_dollar": 5972.46, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ HMO POS", "methodology": "fee schedule", "standard_charge_dollar": 6618.24, "additional_payer_notes": "177.30% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ Indemnity", "methodology": "fee schedule", "standard_charge_dollar": 6618.24, "additional_payer_notes": "177.30% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ PPO", "methodology": "fee schedule", "standard_charge_dollar": 6618.24, "additional_payer_notes": "177.30% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3732.79, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Military Tricare", "methodology": "fee schedule", "standard_charge_dollar": 2986.23, "additional_payer_notes": "80.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3732.79, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 3732.79, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC All Payer (02-01-2023 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 4292.49 }, { "payer_name": "UHC", "plan_name": "UHC Oxford (02-01-2023 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 4292.49 }, { "payer_name": "UHC - Adhoc", "plan_name": "UHC - Adhoc All Payer", "methodology": "fee schedule", "standard_charge_dollar": 2861.66 }, { "payer_name": "UHC - Adhoc", "plan_name": "UHC - Adhoc Oxford", "methodology": "fee schedule", "standard_charge_dollar": 2861.66 }, { "payer_name": "Wellcare", "plan_name": "Wellcare Insurance Exchange", "methodology": "fee schedule", "standard_charge_dollar": 5039.27, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3732.79, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3732.79, "additional_payer_notes": "100.00% of Medicare Rates" } ] } ] }, { "description": "INFECTIOUS & PARASITIC DISEASES INCLUDING HIV W O.R. PROCEDURE - SOI : 1", "code_information": [ { "code": "7101", "type": "APR-DRG" } ], "standard_charges": [ { "setting": "inpatient", "minimum": 12552.54, "maximum": 13807.79, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Better Health - Medi Medi", "methodology": "case rate", "standard_charge_dollar": 13807.79, "additional_payer_notes": "110% of State Medicaid Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Better Health Medicaid", "methodology": "case rate", "standard_charge_dollar": 13807.79, "additional_payer_notes": "110% of State Medicaid Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "case rate", "standard_charge_dollar": 12552.54, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "UBH", "plan_name": "UBH Medicaid", "methodology": "case rate", "standard_charge_dollar": 12552.54, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicaid (02/01/2023 to 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 12803.59, "additional_payer_notes": "102% of State Medicaid Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicaid", "methodology": "case rate", "standard_charge_dollar": 12552.54, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup Medicaid", "methodology": "case rate", "standard_charge_dollar": 12552.54, "additional_payer_notes": "100% of State Medicaid Rates" } ] } ] }, { "description": "Hc Xtrnl Ocular Photog W/I&R Docmt Medical Progre", "code_information": [ { "code": "92285", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 287.4, "discounted_cash": 44.0, "minimum": 35.32, "maximum": 287.4, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 93.6, "additional_payer_notes": "212.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medical Rental Network", "methodology": "fee schedule", "standard_charge_dollar": 93.6, "additional_payer_notes": "212.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 44.15, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "ALLY-ALIGN (FKA SPARTAN PLAN NJ, INC.)", "plan_name": "ALLY-ALIGN (FKA SPARTAN PLAN NJ, INC.)", "methodology": "fee schedule", "standard_charge_dollar": 46.36, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Americhoice (UHC)", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 44.15, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Amerihealth", "plan_name": "Amerihealth HMO", "methodology": "fee schedule", "standard_charge_dollar": 67.29 }, { "payer_name": "Amerihealth", "plan_name": "Amerihealth Medicare", "methodology": "fee schedule", "standard_charge_dollar": 44.15, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 64.88, "additional_payer_notes": "146.95% of Medicare Rates" }, { "payer_name": "Clover Health", "plan_name": "Clover Medicare", "methodology": "fee schedule", "standard_charge_dollar": 44.15, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Coventry", "plan_name": "Coventry Auto", "methodology": "fee schedule", "standard_charge_dollar": 88.3, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Coventry", "plan_name": "Coventry Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 88.3, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "fee schedule", "standard_charge_dollar": 61.81, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Fairprice Healthcare Holdings", "plan_name": "Fairprice Healthcare Holdings", "methodology": "fee schedule", "standard_charge_dollar": 70.64, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ HMO POS", "methodology": "fee schedule", "standard_charge_dollar": 78.28, "additional_payer_notes": "177.30% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ Indemnity", "methodology": "fee schedule", "standard_charge_dollar": 78.28, "additional_payer_notes": "177.30% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ PPO", "methodology": "fee schedule", "standard_charge_dollar": 78.28, "additional_payer_notes": "177.30% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon Medicare", "methodology": "fee schedule", "standard_charge_dollar": 44.15, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Military Tricare", "methodology": "fee schedule", "standard_charge_dollar": 35.32, "additional_payer_notes": "80.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 44.15, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 44.15, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC All Payer (02-01-2023 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 287.4 }, { "payer_name": "UHC", "plan_name": "UHC Oxford (02-01-2023 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 287.4 }, { "payer_name": "UHC - Adhoc", "plan_name": "UHC - Adhoc All Payer", "methodology": "fee schedule", "standard_charge_dollar": 287.4 }, { "payer_name": "UHC - Adhoc", "plan_name": "UHC - Adhoc Oxford", "methodology": "fee schedule", "standard_charge_dollar": 287.4 }, { "payer_name": "Wellcare", "plan_name": "Wellcare Insurance Exchange", "methodology": "fee schedule", "standard_charge_dollar": 59.6, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 44.15, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup Medicare", "methodology": "fee schedule", "standard_charge_dollar": 44.15, "additional_payer_notes": "100.00% of Medicare Rates" } ] } ] }, { "description": "SKIN ULCERS - SOI : 1", "code_information": [ { "code": "3801", "type": "APR-DRG" } ], "standard_charges": [ { "setting": "inpatient", "minimum": 6660.43, "maximum": 7326.48, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Better Health - Medi Medi", "methodology": "case rate", "standard_charge_dollar": 7326.48, "additional_payer_notes": "110% of State Medicaid Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Better Health Medicaid", "methodology": "case rate", "standard_charge_dollar": 7326.48, "additional_payer_notes": "110% of State Medicaid Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "case rate", "standard_charge_dollar": 6660.43, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "UBH", "plan_name": "UBH Medicaid", "methodology": "case rate", "standard_charge_dollar": 6660.43, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicaid (02/01/2023 to 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 6793.64, "additional_payer_notes": "102% of State Medicaid Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicaid", "methodology": "case rate", "standard_charge_dollar": 6660.43, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup Medicaid", "methodology": "case rate", "standard_charge_dollar": 6660.43, "additional_payer_notes": "100% of State Medicaid Rates" } ] } ] }, { "description": "Hc Repair Mouth Laceration,<2.5 Cm", "code_information": [ { "code": "40830", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 768.37, "discounted_cash": 280.0, "minimum": 146.6818, "maximum": 768.37, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 593.6, "additional_payer_notes": "212.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medical Rental Network", "methodology": "fee schedule", "standard_charge_dollar": 593.6, "additional_payer_notes": "212.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 280.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "ALLY-ALIGN (FKA SPARTAN PLAN NJ, INC.)", "plan_name": "ALLY-ALIGN (FKA SPARTAN PLAN NJ, INC.)", "methodology": "fee schedule", "standard_charge_dollar": 294.0, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Americhoice (UHC)", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 280.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Amerihealth", "plan_name": "Amerihealth Medicare", "methodology": "fee schedule", "standard_charge_dollar": 280.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 411.46, "additional_payer_notes": "146.95% of Medicare Rates" }, { "payer_name": "Clover Health", "plan_name": "Clover Medicare", "methodology": "fee schedule", "standard_charge_dollar": 280.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Coventry", "plan_name": "Coventry Auto", "methodology": "fee schedule", "standard_charge_dollar": 560.0, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Coventry", "plan_name": "Coventry Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 560.0, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "fee schedule", "standard_charge_dollar": 392.0, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Fairprice Healthcare Holdings", "plan_name": "Fairprice Healthcare Holdings", "methodology": "fee schedule", "standard_charge_dollar": 448.0, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ HMO POS", "methodology": "fee schedule", "standard_charge_dollar": 496.44, "additional_payer_notes": "177.30% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ Indemnity", "methodology": "fee schedule", "standard_charge_dollar": 496.44, "additional_payer_notes": "177.30% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ PPO", "methodology": "fee schedule", "standard_charge_dollar": 496.44, "additional_payer_notes": "177.30% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon Medicare", "methodology": "fee schedule", "standard_charge_dollar": 280.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Military Tricare", "methodology": "fee schedule", "standard_charge_dollar": 224.0, "additional_payer_notes": "80.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 280.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 280.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC All Payer (02-01-2023 to 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 768.37 }, { "payer_name": "UHC", "plan_name": "UHC Oxford (02-01-2023 to 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 768.37 }, { "payer_name": "UHC - Adhoc", "plan_name": "UHC - Adhoc All Payer", "methodology": "case rate", "standard_charge_dollar": 768.37 }, { "payer_name": "UHC - Adhoc", "plan_name": "UHC - Adhoc Oxford", "methodology": "case rate", "standard_charge_dollar": 768.37 }, { "payer_name": "Wellcare", "plan_name": "Wellcare Insurance Exchange", "methodology": "fee schedule", "standard_charge_dollar": 378.0, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 280.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellchoice", "plan_name": "WELLCHOICE HMO of NJ (Empire) Commercial (HMO / HMO POS, PPO)", "methodology": "case rate", "standard_charge_dollar": 768.37 }, { "payer_name": "Wellchoice", "plan_name": "WELLCHOICE HMO of NJ (Empire) Commercial (Indemnity)", "methodology": "case rate", "standard_charge_dollar": 768.37 }, { "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup Medicare", "methodology": "fee schedule", "standard_charge_dollar": 280.0, "additional_payer_notes": "100.00% of Medicare Rates" } ] } ] }, { "description": "Repair fingerhand tendon - 26356 - ", "code_information": [ { "code": "26356", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 12550.19, "discounted_cash": 3868.0, "minimum": 1715.0, "maximum": 10040.152, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 8200.52, "additional_payer_notes": "212.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medical Rental Network", "methodology": "fee schedule", "standard_charge_dollar": 8200.52, "additional_payer_notes": "212.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3868.17, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "ALLY-ALIGN (FKA SPARTAN PLAN NJ, INC.)", "plan_name": "ALLY-ALIGN (FKA SPARTAN PLAN NJ, INC.)", "methodology": "fee schedule", "standard_charge_dollar": 4061.58, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Americhoice (UHC)", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3868.17, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Amerihealth", "plan_name": "Amerihealth Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3868.17, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 5684.28, "additional_payer_notes": "146.95% of Medicare Rates" }, { "payer_name": "Clover Health", "plan_name": "Clover Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3868.17, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Coventry", "plan_name": "Coventry Auto", "methodology": "fee schedule", "standard_charge_dollar": 7736.34, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Coventry", "plan_name": "Coventry Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 7736.34, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "fee schedule", "standard_charge_dollar": 5415.44, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Fairprice Healthcare Holdings", "plan_name": "Fairprice Healthcare Holdings", "methodology": "fee schedule", "standard_charge_dollar": 6189.07, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ HMO POS", "methodology": "fee schedule", "standard_charge_dollar": 6858.27, "additional_payer_notes": "177.30% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ Indemnity", "methodology": "fee schedule", "standard_charge_dollar": 6858.27, "additional_payer_notes": "177.30% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ PPO", "methodology": "fee schedule", "standard_charge_dollar": 6858.27, "additional_payer_notes": "177.30% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3868.17, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon NJ Health Medicaid", "methodology": "percent of total billed charges", "standard_charge_percentage": 19.58, "median_amount": 565.0, "10th_percentile": 565.0, "90th_percentile": 2260.03, "count": "1 through 10" }, { "payer_name": "Humana", "plan_name": "Humana Military Tricare", "methodology": "fee schedule", "standard_charge_dollar": 3094.54, "additional_payer_notes": "80.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3868.17, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 3868.17, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC All Payer (02-01-2023 to 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 5378.0 }, { "payer_name": "UHC", "plan_name": "UHC Oxford (02-01-2023 to 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 5169.0 }, { "payer_name": "UHC - Adhoc", "plan_name": "UHC - Adhoc All Payer", "methodology": "case rate", "standard_charge_dollar": 5709.0 }, { "payer_name": "UHC - Adhoc", "plan_name": "UHC - Adhoc Oxford", "methodology": "case rate", "standard_charge_dollar": 5327.0 }, { "payer_name": "Wellcare", "plan_name": "Wellcare Insurance Exchange", "methodology": "fee schedule", "standard_charge_dollar": 5222.03, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3868.17, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellchoice", "plan_name": "WELLCHOICE HMO of NJ (Empire) Commercial (HMO / HMO POS, PPO)", "methodology": "case rate", "standard_charge_dollar": 1715.0 }, { "payer_name": "Wellchoice", "plan_name": "WELLCHOICE HMO of NJ (Empire) Commercial (Indemnity)", "methodology": "case rate", "standard_charge_dollar": 1978.0 }, { "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3868.17, "additional_payer_notes": "100.00% of Medicare Rates" } ] } ] }, { "description": "VENTRICULAR SHUNT PROCEDURES WITHOUT CCMCC", "code_information": [ { "code": "033", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 20773.0, "minimum": 10538.56, "maximum": 37600.8857, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "case rate", "standard_charge_dollar": 37600.89, "additional_payer_notes": "181.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medical Rental Network", "methodology": "case rate", "standard_charge_dollar": 37600.89, "additional_payer_notes": "181.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "case rate", "standard_charge_dollar": 16987.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "ALLY-ALIGN (FKA SPARTAN PLAN NJ, INC.)", "plan_name": "ALLY-ALIGN (FKA SPARTAN PLAN NJ, INC.)", "methodology": "case rate", "standard_charge_dollar": 21812.67, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Americhoice (UHC)", "plan_name": "UHC Medicare", "methodology": "case rate", "standard_charge_dollar": 16987.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Amerihealth", "plan_name": "Amerihealth Medicare", "methodology": "case rate", "standard_charge_dollar": 16987.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Commercial", "methodology": "case rate", "standard_charge_dollar": 24328.23 }, { "payer_name": "Clover Health", "plan_name": "Clover Medicare", "methodology": "case rate", "standard_charge_dollar": 16987.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Coventry", "plan_name": "Coventry Auto", "methodology": "case rate", "standard_charge_dollar": 35315.75, "additional_payer_notes": "170.00% of Medicare Rates" }, { "payer_name": "Coventry", "plan_name": "Coventry Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 35315.75, "additional_payer_notes": "170.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "case rate", "standard_charge_dollar": 27006.16, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Fairprice Healthcare Holdings", "plan_name": "Fairprice Healthcare Holdings", "methodology": "case rate", "standard_charge_dollar": 33238.35, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon Medicare", "methodology": "case rate", "standard_charge_dollar": 16987.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon NJ Health Medicaid", "methodology": "case rate", "standard_charge_dollar": 10538.56 }, { "payer_name": "Humana", "plan_name": "Humana Military Tricare", "methodology": "case rate", "standard_charge_dollar": 16619.18, "additional_payer_notes": "80.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 20773.97, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 23360.8 }, { "payer_name": "UBH", "plan_name": "UBH Medicare", "methodology": "case rate", "standard_charge_dollar": 16987.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC All Payer (02-01-2023 to 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 28029.84 }, { "payer_name": "UHC", "plan_name": "UHC Oxford (02-01-2023 to 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 24428.0 }, { "payer_name": "UHC - Adhoc", "plan_name": "UHC - Adhoc All Payer", "methodology": "case rate", "standard_charge_dollar": 29754.27 }, { "payer_name": "UHC - Adhoc", "plan_name": "UHC - Adhoc Oxford", "methodology": "case rate", "standard_charge_dollar": 25172.98 }, { "payer_name": "Wellcare", "plan_name": "Wellcare Insurance Exchange", "methodology": "case rate", "standard_charge_dollar": 28044.86, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "case rate", "standard_charge_dollar": 16987.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup Medicare", "methodology": "case rate", "standard_charge_dollar": 16987.7, "additional_payer_notes": "100.00% of Medicare Rates" } ] } ] }, { "description": "Hc Clsd Treat A-C Jt Disloc Wo Manip", "code_information": [ { "code": "23540", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 839.01, "discounted_cash": 291.0, "minimum": 160.167, "maximum": 839.01, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 618.19, "additional_payer_notes": "212.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medical Rental Network", "methodology": "fee schedule", "standard_charge_dollar": 618.19, "additional_payer_notes": "212.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 291.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "ALLY-ALIGN (FKA SPARTAN PLAN NJ, INC.)", "plan_name": "ALLY-ALIGN (FKA SPARTAN PLAN NJ, INC.)", "methodology": "fee schedule", "standard_charge_dollar": 306.18, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Americhoice (UHC)", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 291.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Amerihealth", "plan_name": "Amerihealth Medicare", "methodology": "fee schedule", "standard_charge_dollar": 291.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 428.51, "additional_payer_notes": "146.95% of Medicare Rates" }, { "payer_name": "Clover Health", "plan_name": "Clover Medicare", "methodology": "fee schedule", "standard_charge_dollar": 291.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Coventry", "plan_name": "Coventry Auto", "methodology": "fee schedule", "standard_charge_dollar": 583.2, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Coventry", "plan_name": "Coventry Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 583.2, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "fee schedule", "standard_charge_dollar": 408.24, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Fairprice Healthcare Holdings", "plan_name": "Fairprice Healthcare Holdings", "methodology": "fee schedule", "standard_charge_dollar": 466.56, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ HMO POS", "methodology": "fee schedule", "standard_charge_dollar": 517.01, "additional_payer_notes": "177.30% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ Indemnity", "methodology": "fee schedule", "standard_charge_dollar": 517.01, "additional_payer_notes": "177.30% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ PPO", "methodology": "fee schedule", "standard_charge_dollar": 517.01, "additional_payer_notes": "177.30% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon Medicare", "methodology": "fee schedule", "standard_charge_dollar": 291.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Military Tricare", "methodology": "fee schedule", "standard_charge_dollar": 233.28, "additional_payer_notes": "80.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 291.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 291.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC All Payer (02-01-2023 to 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 839.01 }, { "payer_name": "UHC", "plan_name": "UHC Oxford (02-01-2023 to 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 839.01 }, { "payer_name": "UHC - Adhoc", "plan_name": "UHC - Adhoc All Payer", "methodology": "case rate", "standard_charge_dollar": 839.01 }, { "payer_name": "UHC - Adhoc", "plan_name": "UHC - Adhoc Oxford", "methodology": "case rate", "standard_charge_dollar": 839.01 }, { "payer_name": "Wellcare", "plan_name": "Wellcare Insurance Exchange", "methodology": "fee schedule", "standard_charge_dollar": 393.66, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 291.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup Medicare", "methodology": "fee schedule", "standard_charge_dollar": 291.6, "additional_payer_notes": "100.00% of Medicare Rates" } ] } ] }, { "description": "OTHER MALE REPRODUCTIVE SYSTEM & RELATED PROCEDURES - SOI : 4", "code_information": [ { "code": "4844", "type": "APR-DRG" } ], "standard_charges": [ { "setting": "inpatient", "minimum": 47329.29, "maximum": 52062.21, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Better Health - Medi Medi", "methodology": "case rate", "standard_charge_dollar": 52062.21, "additional_payer_notes": "110% of State Medicaid Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Better Health Medicaid", "methodology": "case rate", "standard_charge_dollar": 52062.21, "additional_payer_notes": "110% of State Medicaid Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "case rate", "standard_charge_dollar": 47329.29, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "UBH", "plan_name": "UBH Medicaid", "methodology": "case rate", "standard_charge_dollar": 47329.29, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicaid (02/01/2023 to 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 48275.87, "additional_payer_notes": "102% of State Medicaid Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicaid", "methodology": "case rate", "standard_charge_dollar": 47329.29, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup Medicaid", "methodology": "case rate", "standard_charge_dollar": 47329.29, "additional_payer_notes": "100% of State Medicaid Rates" } ] } ] }, { "description": "Hc Compatibility Test,Spin Tech", "code_information": [ { "code": "86920", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 701.2, "discounted_cash": 201.0, "minimum": 12.0, "maximum": 596.02, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 426.99, "additional_payer_notes": "212.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medical Rental Network", "methodology": "fee schedule", "standard_charge_dollar": 426.99, "additional_payer_notes": "212.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 201.41, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "ALLY-ALIGN (FKA SPARTAN PLAN NJ, INC.)", "plan_name": "ALLY-ALIGN (FKA SPARTAN PLAN NJ, INC.)", "methodology": "fee schedule", "standard_charge_dollar": 211.48, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Americhoice (UHC)", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 201.41, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Amerihealth", "plan_name": "Amerihealth Medicare", "methodology": "fee schedule", "standard_charge_dollar": 201.41, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 295.97, "additional_payer_notes": "146.95% of Medicare Rates" }, { "payer_name": "Clover Health", "plan_name": "Clover Medicare", "methodology": "fee schedule", "standard_charge_dollar": 201.41, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Coventry", "plan_name": "Coventry Auto", "methodology": "fee schedule", "standard_charge_dollar": 402.82, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Coventry", "plan_name": "Coventry Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 402.82, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "fee schedule", "standard_charge_dollar": 281.97, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Fairprice Healthcare Holdings", "plan_name": "Fairprice Healthcare Holdings", "methodology": "fee schedule", "standard_charge_dollar": 322.26, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ HMO POS", "methodology": "fee schedule", "standard_charge_dollar": 357.1, "additional_payer_notes": "177.30% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ Indemnity", "methodology": "fee schedule", "standard_charge_dollar": 357.1, "additional_payer_notes": "177.30% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ PPO", "methodology": "fee schedule", "standard_charge_dollar": 357.1, "additional_payer_notes": "177.30% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon Medicare", "methodology": "fee schedule", "standard_charge_dollar": 201.41, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Military Tricare", "methodology": "fee schedule", "standard_charge_dollar": 161.13, "additional_payer_notes": "80.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 201.41, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 201.41, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC All Payer (02-01-2023 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 86.1 }, { "payer_name": "UHC", "plan_name": "UHC Medicaid (02/01/2023 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 12.0 }, { "payer_name": "UHC", "plan_name": "UHC Oxford (02-01-2023 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 86.1 }, { "payer_name": "UHC - Adhoc", "plan_name": "UHC - Adhoc All Payer", "methodology": "fee schedule", "standard_charge_dollar": 143.5 }, { "payer_name": "UHC - Adhoc", "plan_name": "UHC - Adhoc Oxford", "methodology": "fee schedule", "standard_charge_dollar": 143.5 }, { "payer_name": "Wellcare", "plan_name": "Wellcare Insurance Exchange", "methodology": "fee schedule", "standard_charge_dollar": 271.9, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 201.41, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup Medicaid", "methodology": "percent of total billed charges", "standard_charge_percentage": 19.09, "median_amount": 130.77, "10th_percentile": 130.77, "90th_percentile": 130.77, "count": "1 through 10" }, { "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup Medicare", "methodology": "fee schedule", "standard_charge_dollar": 201.41, "additional_payer_notes": "100.00% of Medicare Rates" } ] } ] }, { "description": "OTHER DRUG ABUSE & DEPENDENCE - SOI : 3", "code_information": [ { "code": "7763", "type": "APR-DRG" } ], "standard_charges": [ { "setting": "inpatient", "minimum": 9474.36, "maximum": 10421.79, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Better Health - Medi Medi", "methodology": "case rate", "standard_charge_dollar": 10421.79, "additional_payer_notes": "110% of State Medicaid Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Better Health Medicaid", "methodology": "case rate", "standard_charge_dollar": 10421.79, "additional_payer_notes": "110% of State Medicaid Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "case rate", "standard_charge_dollar": 9474.36, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "UBH", "plan_name": "UBH Medicaid", "methodology": "case rate", "standard_charge_dollar": 9474.36, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicaid (02/01/2023 to 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 9663.84, "additional_payer_notes": "102% of State Medicaid Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicaid", "methodology": "case rate", "standard_charge_dollar": 9474.36, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup Medicaid", "methodology": "case rate", "standard_charge_dollar": 9474.36, "additional_payer_notes": "100% of State Medicaid Rates" } ] } ] }, { "description": "MINOR BLADDER PROCEDURES WITH MCC", "code_information": [ { "code": "662", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 36936.0, "minimum": 19848.87, "maximum": 66855.6985, "payers_information": [ { "payer_name": "Horizon", "plan_name": "Horizon NJ Health Medicaid", "methodology": "case rate", "standard_charge_dollar": 19848.87 }, { "payer_name": "Humana", "plan_name": "Humana Military Tricare", "methodology": "case rate", "standard_charge_dollar": 29549.48, "additional_payer_notes": "80.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 36936.85, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 45387.3 }, { "payer_name": "UBH", "plan_name": "UBH Medicare", "methodology": "case rate", "standard_charge_dollar": 29966.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC All Payer (02-01-2023 to 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 51604.64 }, { "payer_name": "UHC", "plan_name": "UHC Oxford (02-01-2023 to 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 44973.44 }, { "payer_name": "UHC - Adhoc", "plan_name": "UHC - Adhoc All Payer", "methodology": "case rate", "standard_charge_dollar": 54779.42 }, { "payer_name": "UHC - Adhoc", "plan_name": "UHC - Adhoc Oxford", "methodology": "case rate", "standard_charge_dollar": 46344.99 }, { "payer_name": "Wellcare", "plan_name": "Wellcare Insurance Exchange", "methodology": "case rate", "standard_charge_dollar": 49864.75, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "case rate", "standard_charge_dollar": 29966.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup Medicare", "methodology": "case rate", "standard_charge_dollar": 29966.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "case rate", "standard_charge_dollar": 66855.7, "additional_payer_notes": "181.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medical Rental Network", "methodology": "case rate", "standard_charge_dollar": 66855.7, "additional_payer_notes": "181.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "case rate", "standard_charge_dollar": 29966.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "ALLY-ALIGN (FKA SPARTAN PLAN NJ, INC.)", "plan_name": "ALLY-ALIGN (FKA SPARTAN PLAN NJ, INC.)", "methodology": "case rate", "standard_charge_dollar": 38783.69, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Americhoice (UHC)", "plan_name": "UHC Medicare", "methodology": "case rate", "standard_charge_dollar": 29966.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Amerihealth", "plan_name": "Amerihealth Medicare", "methodology": "case rate", "standard_charge_dollar": 29966.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Commercial", "methodology": "case rate", "standard_charge_dollar": 44789.75 }, { "payer_name": "Clover Health", "plan_name": "Clover Medicare", "methodology": "case rate", "standard_charge_dollar": 29966.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Coventry", "plan_name": "Coventry Auto", "methodology": "case rate", "standard_charge_dollar": 62792.65, "additional_payer_notes": "170.00% of Medicare Rates" }, { "payer_name": "Coventry", "plan_name": "Coventry Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 62792.65, "additional_payer_notes": "170.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "case rate", "standard_charge_dollar": 48017.91, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Fairprice Healthcare Holdings", "plan_name": "Fairprice Healthcare Holdings", "methodology": "case rate", "standard_charge_dollar": 59098.96, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon Medicare", "methodology": "case rate", "standard_charge_dollar": 29966.0, "additional_payer_notes": "100.00% of Medicare Rates" } ] } ] }, { "description": "Hc Rbc Leukocytes Reduced, Per Unit", "code_information": [ { "code": "P9016", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 641.91, "discounted_cash": 184.0, "minimum": 119.8852, "maximum": 513.528, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 390.08, "additional_payer_notes": "212.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medical Rental Network", "methodology": "fee schedule", "standard_charge_dollar": 390.08, "additional_payer_notes": "212.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 184.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "ALLY-ALIGN (FKA SPARTAN PLAN NJ, INC.)", "plan_name": "ALLY-ALIGN (FKA SPARTAN PLAN NJ, INC.)", "methodology": "fee schedule", "standard_charge_dollar": 193.2, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Americhoice (UHC)", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 184.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Amerihealth", "plan_name": "Amerihealth Medicare", "methodology": "fee schedule", "standard_charge_dollar": 184.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 270.39, "additional_payer_notes": "146.95% of Medicare Rates" }, { "payer_name": "Clover Health", "plan_name": "Clover Medicare", "methodology": "fee schedule", "standard_charge_dollar": 184.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Coventry", "plan_name": "Coventry Auto", "methodology": "fee schedule", "standard_charge_dollar": 368.0, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Coventry", "plan_name": "Coventry Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 368.0, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "fee schedule", "standard_charge_dollar": 257.6, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Fairprice Healthcare Holdings", "plan_name": "Fairprice Healthcare Holdings", "methodology": "fee schedule", "standard_charge_dollar": 294.4, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ HMO POS", "methodology": "fee schedule", "standard_charge_dollar": 326.23, "additional_payer_notes": "177.30% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ Indemnity", "methodology": "fee schedule", "standard_charge_dollar": 326.23, "additional_payer_notes": "177.30% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ PPO", "methodology": "fee schedule", "standard_charge_dollar": 326.23, "additional_payer_notes": "177.30% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon Medicare", "methodology": "fee schedule", "standard_charge_dollar": 184.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Military Tricare", "methodology": "fee schedule", "standard_charge_dollar": 147.2, "additional_payer_notes": "80.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 184.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 184.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicaid (02/01/2023 to 12-31-2026)", "methodology": "percent of total billed charges", "standard_charge_percentage": 19.47, "median_amount": 119.46, "10th_percentile": 119.46, "90th_percentile": 122.11, "count": "1 through 10" }, { "payer_name": "UHC", "plan_name": "UHC Oxford (02-01-2023 to 12-31-2026)", "methodology": "percent of total billed charges", "standard_charge_percentage": 60.0, "median_amount": 385.15, "10th_percentile": 385.15, "90th_percentile": 385.15, "count": "1 through 10" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Insurance Exchange", "methodology": "fee schedule", "standard_charge_dollar": 248.4, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 184.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup Medicaid", "methodology": "percent of total billed charges", "standard_charge_percentage": 19.09, "median_amount": 119.72, "10th_percentile": 119.72, "90th_percentile": 119.72, "count": "1 through 10" }, { "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup Medicare", "methodology": "fee schedule", "standard_charge_dollar": 184.0, "additional_payer_notes": "100.00% of Medicare Rates" } ] } ] }, { "description": "Hc Coronary Artery Bypass 6/+ Coronary Venous Graft", "code_information": [ { "code": "33516", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 4700.0, "minimum": 897.23, "maximum": 4700.0, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2834.62, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC All Payer (02-01-2023 to 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 4700.0 }, { "payer_name": "UHC", "plan_name": "UHC Oxford (02-01-2023 to 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 4020.0 }, { "payer_name": "UHC - Adhoc", "plan_name": "UHC - Adhoc All Payer", "methodology": "case rate", "standard_charge_dollar": 4700.0 }, { "payer_name": "UHC - Adhoc", "plan_name": "UHC - Adhoc Oxford", "methodology": "case rate", "standard_charge_dollar": 4143.0 }, { "payer_name": "Wellchoice", "plan_name": "WELLCHOICE HMO of NJ (Empire) Commercial (HMO / HMO POS, PPO)", "methodology": "case rate", "standard_charge_dollar": 1715.0 }, { "payer_name": "Wellchoice", "plan_name": "WELLCHOICE HMO of NJ (Empire) Commercial (Indemnity)", "methodology": "case rate", "standard_charge_dollar": 1978.0 } ] } ] }, { "description": "Hc Mri Spinal Canal Thoracic W/Contrast", "code_information": [ { "code": "72147", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 3600.4, "discounted_cash": 412.0, "minimum": 329.952, "maximum": 3060.34, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 874.37, "additional_payer_notes": "212.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medical Rental Network", "methodology": "fee schedule", "standard_charge_dollar": 874.37, "additional_payer_notes": "212.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 412.44, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "ALLY-ALIGN (FKA SPARTAN PLAN NJ, INC.)", "plan_name": "ALLY-ALIGN (FKA SPARTAN PLAN NJ, INC.)", "methodology": "fee schedule", "standard_charge_dollar": 433.06, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Americhoice (UHC)", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 412.44, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Amerihealth", "plan_name": "Amerihealth HMO", "methodology": "fee schedule", "standard_charge_dollar": 886.6 }, { "payer_name": "Amerihealth", "plan_name": "Amerihealth Medicare", "methodology": "fee schedule", "standard_charge_dollar": 412.44, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 606.08, "additional_payer_notes": "146.95% of Medicare Rates" }, { "payer_name": "Clover Health", "plan_name": "Clover Medicare", "methodology": "fee schedule", "standard_charge_dollar": 412.44, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Coventry", "plan_name": "Coventry Auto", "methodology": "fee schedule", "standard_charge_dollar": 824.88, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Coventry", "plan_name": "Coventry Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 824.88, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "fee schedule", "standard_charge_dollar": 577.42, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Fairprice Healthcare Holdings", "plan_name": "Fairprice Healthcare Holdings", "methodology": "fee schedule", "standard_charge_dollar": 659.9, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ HMO POS", "methodology": "fee schedule", "standard_charge_dollar": 731.26, "additional_payer_notes": "177.30% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ Indemnity", "methodology": "fee schedule", "standard_charge_dollar": 731.26, "additional_payer_notes": "177.30% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ PPO", "methodology": "fee schedule", "standard_charge_dollar": 731.26, "additional_payer_notes": "177.30% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon Medicare", "methodology": "fee schedule", "standard_charge_dollar": 412.44, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Military Tricare", "methodology": "fee schedule", "standard_charge_dollar": 329.95, "additional_payer_notes": "80.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 412.44, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 412.44, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC All Payer (02-01-2023 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 552.18 }, { "payer_name": "UHC", "plan_name": "UHC Oxford (02-01-2023 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 552.18 }, { "payer_name": "UHC - Adhoc", "plan_name": "UHC - Adhoc All Payer", "methodology": "fee schedule", "standard_charge_dollar": 368.12 }, { "payer_name": "UHC - Adhoc", "plan_name": "UHC - Adhoc Oxford", "methodology": "fee schedule", "standard_charge_dollar": 368.12 }, { "payer_name": "Wellcare", "plan_name": "Wellcare Insurance Exchange", "methodology": "fee schedule", "standard_charge_dollar": 556.79, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 412.44, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup Medicare", "methodology": "fee schedule", "standard_charge_dollar": 412.44, "additional_payer_notes": "100.00% of Medicare Rates" } ] } ] }, { "description": "Hc Tte 2D W Or W/O Fol W/Con Limited - 93308 - 48300015", "code_information": [ { "code": "93308", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 1167.6, "discounted_cash": 282.0, "minimum": 220.0695, "maximum": 1167.6, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 597.99, "additional_payer_notes": "212.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medical Rental Network", "methodology": "fee schedule", "standard_charge_dollar": 597.99, "additional_payer_notes": "212.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 282.07, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "ALLY-ALIGN (FKA SPARTAN PLAN NJ, INC.)", "plan_name": "ALLY-ALIGN (FKA SPARTAN PLAN NJ, INC.)", "methodology": "fee schedule", "standard_charge_dollar": 296.17, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Americhoice (UHC)", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 282.07, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Amerihealth", "plan_name": "Amerihealth Medicare", "methodology": "fee schedule", "standard_charge_dollar": 282.07, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 414.5, "additional_payer_notes": "146.95% of Medicare Rates" }, { "payer_name": "Clover Health", "plan_name": "Clover Medicare", "methodology": "fee schedule", "standard_charge_dollar": 282.07, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Coventry", "plan_name": "Coventry Auto", "methodology": "fee schedule", "standard_charge_dollar": 564.14, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Coventry", "plan_name": "Coventry Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 564.14, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "fee schedule", "standard_charge_dollar": 394.9, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Fairprice Healthcare Holdings", "plan_name": "Fairprice Healthcare Holdings", "methodology": "fee schedule", "standard_charge_dollar": 451.31, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ HMO POS", "methodology": "fee schedule", "standard_charge_dollar": 500.11, "additional_payer_notes": "177.30% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ Indemnity", "methodology": "fee schedule", "standard_charge_dollar": 500.11, "additional_payer_notes": "177.30% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ PPO", "methodology": "fee schedule", "standard_charge_dollar": 500.11, "additional_payer_notes": "177.30% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon Medicare", "methodology": "fee schedule", "standard_charge_dollar": 282.07, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon NJ Health Medicaid", "methodology": "percent of total billed charges", "standard_charge_percentage": 19.58, "median_amount": 228.62, "10th_percentile": 225.72, "90th_percentile": 284.66, "count": "1 through 10" }, { "payer_name": "Humana", "plan_name": "Humana Military Tricare", "methodology": "fee schedule", "standard_charge_dollar": 225.66, "additional_payer_notes": "80.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 282.07, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 282.07, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC All Payer (02-01-2023 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 1167.6 }, { "payer_name": "UHC", "plan_name": "UHC Medicaid (02/01/2023 to 12-31-2026)", "methodology": "percent of total billed charges", "standard_charge_percentage": 19.47, "median_amount": 282.08, "10th_percentile": 282.08, "90th_percentile": 282.08, "count": "1 through 10" }, { "payer_name": "UHC", "plan_name": "UHC Oxford (02-01-2023 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 1167.6 }, { "payer_name": "UHC - Adhoc", "plan_name": "UHC - Adhoc All Payer", "methodology": "fee schedule", "standard_charge_dollar": 1167.6 }, { "payer_name": "UHC - Adhoc", "plan_name": "UHC - Adhoc Oxford", "methodology": "fee schedule", "standard_charge_dollar": 1167.6 }, { "payer_name": "Wellcare", "plan_name": "Wellcare Insurance Exchange", "methodology": "fee schedule", "standard_charge_dollar": 380.79, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 282.07, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup Medicare", "methodology": "fee schedule", "standard_charge_dollar": 282.07, "additional_payer_notes": "100.00% of Medicare Rates" } ] } ] }, { "description": "RESPIRATORY INFECTIONS AND INFLAMMATIONS WITHOUT CCMCC", "code_information": [ { "code": "179", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 10281.0, "minimum": 5754.15, "maximum": 18610.1485, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "case rate", "standard_charge_dollar": 18610.15, "additional_payer_notes": "181.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medical Rental Network", "methodology": "case rate", "standard_charge_dollar": 18610.15, "additional_payer_notes": "181.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "case rate", "standard_charge_dollar": 8562.77, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "ALLY-ALIGN (FKA SPARTAN PLAN NJ, INC.)", "plan_name": "ALLY-ALIGN (FKA SPARTAN PLAN NJ, INC.)", "methodology": "case rate", "standard_charge_dollar": 10795.94, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Americhoice (UHC)", "plan_name": "UHC Medicare", "methodology": "case rate", "standard_charge_dollar": 8562.77, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Amerihealth", "plan_name": "Amerihealth Medicare", "methodology": "case rate", "standard_charge_dollar": 8562.77, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Commercial", "methodology": "case rate", "standard_charge_dollar": 11045.65 }, { "payer_name": "Clover Health", "plan_name": "Clover Medicare", "methodology": "case rate", "standard_charge_dollar": 8562.77, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Coventry", "plan_name": "Coventry Auto", "methodology": "case rate", "standard_charge_dollar": 17479.15, "additional_payer_notes": "170.00% of Medicare Rates" }, { "payer_name": "Coventry", "plan_name": "Coventry Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 17479.15, "additional_payer_notes": "170.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "case rate", "standard_charge_dollar": 13366.41, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Fairprice Healthcare Holdings", "plan_name": "Fairprice Healthcare Holdings", "methodology": "case rate", "standard_charge_dollar": 16450.96, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon Medicare", "methodology": "case rate", "standard_charge_dollar": 8562.77, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon NJ Health Medicaid", "methodology": "case rate", "standard_charge_dollar": 5754.15 }, { "payer_name": "Humana", "plan_name": "Humana Military Tricare", "methodology": "case rate", "standard_charge_dollar": 8225.48, "additional_payer_notes": "80.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 10281.85, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 10464.7 }, { "payer_name": "UBH", "plan_name": "UBH Medicare", "methodology": "case rate", "standard_charge_dollar": 8562.77, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC All Payer (02-01-2023 to 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 12726.28 }, { "payer_name": "UHC", "plan_name": "UHC Oxford (02-01-2023 to 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 11090.95 }, { "payer_name": "UHC - Adhoc", "plan_name": "UHC - Adhoc All Payer", "methodology": "case rate", "standard_charge_dollar": 13509.22 }, { "payer_name": "UHC - Adhoc", "plan_name": "UHC - Adhoc Oxford", "methodology": "case rate", "standard_charge_dollar": 11429.19 }, { "payer_name": "Wellcare", "plan_name": "Wellcare Insurance Exchange", "methodology": "case rate", "standard_charge_dollar": 13880.5, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "case rate", "standard_charge_dollar": 8562.77, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup Medicare", "methodology": "case rate", "standard_charge_dollar": 8562.77, "additional_payer_notes": "100.00% of Medicare Rates" } ] } ] }, { "description": "VIRAL ILLNESS WITH MCC", "code_information": [ { "code": "865", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 18871.0, "minimum": 8630.92, "maximum": 34157.9218, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "case rate", "standard_charge_dollar": 34157.92, "additional_payer_notes": "181.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medical Rental Network", "methodology": "case rate", "standard_charge_dollar": 34157.92, "additional_payer_notes": "181.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "case rate", "standard_charge_dollar": 15460.2, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "ALLY-ALIGN (FKA SPARTAN PLAN NJ, INC.)", "plan_name": "ALLY-ALIGN (FKA SPARTAN PLAN NJ, INC.)", "methodology": "case rate", "standard_charge_dollar": 19815.37, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Americhoice (UHC)", "plan_name": "UHC Medicare", "methodology": "case rate", "standard_charge_dollar": 15460.2, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Amerihealth", "plan_name": "Amerihealth Medicare", "methodology": "case rate", "standard_charge_dollar": 15460.2, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Commercial", "methodology": "case rate", "standard_charge_dollar": 21920.13 }, { "payer_name": "Clover Health", "plan_name": "Clover Medicare", "methodology": "case rate", "standard_charge_dollar": 15460.2, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Coventry", "plan_name": "Coventry Auto", "methodology": "case rate", "standard_charge_dollar": 32082.03, "additional_payer_notes": "170.00% of Medicare Rates" }, { "payer_name": "Coventry", "plan_name": "Coventry Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 32082.03, "additional_payer_notes": "170.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "case rate", "standard_charge_dollar": 24533.31, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Fairprice Healthcare Holdings", "plan_name": "Fairprice Healthcare Holdings", "methodology": "case rate", "standard_charge_dollar": 30194.85, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon Medicare", "methodology": "case rate", "standard_charge_dollar": 15460.2, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon NJ Health Medicaid", "methodology": "case rate", "standard_charge_dollar": 8630.92 }, { "payer_name": "Humana", "plan_name": "Humana Military Tricare", "methodology": "case rate", "standard_charge_dollar": 15097.42, "additional_payer_notes": "80.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 18871.78, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 14415.2 }, { "payer_name": "UBH", "plan_name": "UBH Medicare", "methodology": "case rate", "standard_charge_dollar": 15460.2, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC All Payer (02-01-2023 to 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 25255.34 }, { "payer_name": "UHC", "plan_name": "UHC Oxford (02-01-2023 to 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 22010.03 }, { "payer_name": "UHC - Adhoc", "plan_name": "UHC - Adhoc All Payer", "methodology": "case rate", "standard_charge_dollar": 26809.08 }, { "payer_name": "UHC - Adhoc", "plan_name": "UHC - Adhoc Oxford", "methodology": "case rate", "standard_charge_dollar": 22681.27 }, { "payer_name": "Wellcare", "plan_name": "Wellcare Insurance Exchange", "methodology": "case rate", "standard_charge_dollar": 25476.9, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "case rate", "standard_charge_dollar": 15460.2, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup Medicare", "methodology": "case rate", "standard_charge_dollar": 15460.2, "additional_payer_notes": "100.00% of Medicare Rates" } ] } ] }, { "description": "Hc Thromboplastin Inhibition", "code_information": [ { "code": "85705", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 102.0, "discounted_cash": 9.0, "minimum": 5.78, "maximum": 86.7, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 20.42, "additional_payer_notes": "212.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medical Rental Network", "methodology": "fee schedule", "standard_charge_dollar": 20.42, "additional_payer_notes": "212.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 9.63, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "ALLY-ALIGN (FKA SPARTAN PLAN NJ, INC.)", "plan_name": "ALLY-ALIGN (FKA SPARTAN PLAN NJ, INC.)", "methodology": "fee schedule", "standard_charge_dollar": 10.11, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Americhoice (UHC)", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 9.63, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Amerihealth", "plan_name": "Amerihealth Medicare", "methodology": "fee schedule", "standard_charge_dollar": 9.63, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 13.96, "additional_payer_notes": "Laboratory - 145.00% of Medicare Rates" }, { "payer_name": "Clover Health", "plan_name": "Clover Medicare", "methodology": "fee schedule", "standard_charge_dollar": 9.63, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Coventry", "plan_name": "Coventry Auto", "methodology": "fee schedule", "standard_charge_dollar": 19.26, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Coventry", "plan_name": "Coventry Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 19.26, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "fee schedule", "standard_charge_dollar": 13.48, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Fairprice Healthcare Holdings", "plan_name": "Fairprice Healthcare Holdings", "methodology": "fee schedule", "standard_charge_dollar": 11.56, "additional_payer_notes": "Laboratory - 120.00% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ HMO POS", "methodology": "fee schedule", "standard_charge_dollar": 72.01, "additional_payer_notes": "177.30% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ Indemnity", "methodology": "fee schedule", "standard_charge_dollar": 72.01, "additional_payer_notes": "177.30% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ PPO", "methodology": "fee schedule", "standard_charge_dollar": 72.01, "additional_payer_notes": "177.30% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon Medicare", "methodology": "fee schedule", "standard_charge_dollar": 9.63, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Military Tricare", "methodology": "fee schedule", "standard_charge_dollar": 7.7, "additional_payer_notes": "80.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 9.63, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 9.63, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC All Payer (02-01-2023 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 5.78 }, { "payer_name": "UHC", "plan_name": "UHC Medicaid (02/01/2023 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 7.7 }, { "payer_name": "UHC", "plan_name": "UHC Oxford (02-01-2023 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 5.78 }, { "payer_name": "UHC - Adhoc", "plan_name": "UHC - Adhoc All Payer", "methodology": "fee schedule", "standard_charge_dollar": 9.63 }, { "payer_name": "UHC - Adhoc", "plan_name": "UHC - Adhoc Oxford", "methodology": "fee schedule", "standard_charge_dollar": 9.63 }, { "payer_name": "Wellcare", "plan_name": "Wellcare Insurance Exchange", "methodology": "fee schedule", "standard_charge_dollar": 13.0, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 9.63, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup Medicare", "methodology": "fee schedule", "standard_charge_dollar": 9.63, "additional_payer_notes": "100.00% of Medicare Rates" } ] } ] }, { "description": "Hc Hiv-1 Ag W/Hiv-1 & Hiv-2 Ab", "code_information": [ { "code": "87389", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 120.4, "discounted_cash": 24.0, "minimum": 14.45, "maximum": 102.34, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 51.05, "additional_payer_notes": "212.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medical Rental Network", "methodology": "fee schedule", "standard_charge_dollar": 51.05, "additional_payer_notes": "212.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 24.08, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "ALLY-ALIGN (FKA SPARTAN PLAN NJ, INC.)", "plan_name": "ALLY-ALIGN (FKA SPARTAN PLAN NJ, INC.)", "methodology": "fee schedule", "standard_charge_dollar": 25.28, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Americhoice (UHC)", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 24.08, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Amerihealth", "plan_name": "Amerihealth Medicare", "methodology": "fee schedule", "standard_charge_dollar": 24.08, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 34.92, "additional_payer_notes": "Laboratory - 145.00% of Medicare Rates" }, { "payer_name": "Clover Health", "plan_name": "Clover Medicare", "methodology": "fee schedule", "standard_charge_dollar": 24.08, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Coventry", "plan_name": "Coventry Auto", "methodology": "fee schedule", "standard_charge_dollar": 48.16, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Coventry", "plan_name": "Coventry Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 48.16, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "fee schedule", "standard_charge_dollar": 33.71, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Fairprice Healthcare Holdings", "plan_name": "Fairprice Healthcare Holdings", "methodology": "fee schedule", "standard_charge_dollar": 28.9, "additional_payer_notes": "Laboratory - 120.00% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ HMO POS", "methodology": "fee schedule", "standard_charge_dollar": 85.0, "additional_payer_notes": "177.30% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ Indemnity", "methodology": "fee schedule", "standard_charge_dollar": 85.0, "additional_payer_notes": "177.30% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ PPO", "methodology": "fee schedule", "standard_charge_dollar": 85.0, "additional_payer_notes": "177.30% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon Medicare", "methodology": "fee schedule", "standard_charge_dollar": 24.08, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Military Tricare", "methodology": "fee schedule", "standard_charge_dollar": 19.26, "additional_payer_notes": "80.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 24.08, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 24.08, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC All Payer (02-01-2023 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 14.45 }, { "payer_name": "UHC", "plan_name": "UHC Medicaid (02/01/2023 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 19.26 }, { "payer_name": "UHC", "plan_name": "UHC Oxford (02-01-2023 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 14.45 }, { "payer_name": "UHC - Adhoc", "plan_name": "UHC - Adhoc All Payer", "methodology": "fee schedule", "standard_charge_dollar": 24.08 }, { "payer_name": "UHC - Adhoc", "plan_name": "UHC - Adhoc Oxford", "methodology": "fee schedule", "standard_charge_dollar": 24.08 }, { "payer_name": "Wellcare", "plan_name": "Wellcare Insurance Exchange", "methodology": "fee schedule", "standard_charge_dollar": 32.51, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 24.08, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup Medicare", "methodology": "fee schedule", "standard_charge_dollar": 24.08, "additional_payer_notes": "100.00% of Medicare Rates" } ] } ] }, { "description": "Hc X-Ray Head For Orthodontia", "code_information": [ { "code": "70350", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 399.05, "discounted_cash": 102.0, "minimum": 35.46, "maximum": 339.1925, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 218.08, "additional_payer_notes": "212.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medical Rental Network", "methodology": "fee schedule", "standard_charge_dollar": 218.08, "additional_payer_notes": "212.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 102.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "ALLY-ALIGN (FKA SPARTAN PLAN NJ, INC.)", "plan_name": "ALLY-ALIGN (FKA SPARTAN PLAN NJ, INC.)", "methodology": "fee schedule", "standard_charge_dollar": 108.01, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Americhoice (UHC)", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 102.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Amerihealth", "plan_name": "Amerihealth HMO", "methodology": "fee schedule", "standard_charge_dollar": 35.46 }, { "payer_name": "Amerihealth", "plan_name": "Amerihealth Medicare", "methodology": "fee schedule", "standard_charge_dollar": 102.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 151.17, "additional_payer_notes": "146.95% of Medicare Rates" }, { "payer_name": "Clover Health", "plan_name": "Clover Medicare", "methodology": "fee schedule", "standard_charge_dollar": 102.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Coventry", "plan_name": "Coventry Auto", "methodology": "fee schedule", "standard_charge_dollar": 205.74, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Coventry", "plan_name": "Coventry Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 205.74, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "fee schedule", "standard_charge_dollar": 144.02, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Fairprice Healthcare Holdings", "plan_name": "Fairprice Healthcare Holdings", "methodology": "fee schedule", "standard_charge_dollar": 164.59, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ HMO POS", "methodology": "fee schedule", "standard_charge_dollar": 182.39, "additional_payer_notes": "177.30% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ Indemnity", "methodology": "fee schedule", "standard_charge_dollar": 182.39, "additional_payer_notes": "177.30% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ PPO", "methodology": "fee schedule", "standard_charge_dollar": 182.39, "additional_payer_notes": "177.30% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon Medicare", "methodology": "fee schedule", "standard_charge_dollar": 102.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Military Tricare", "methodology": "fee schedule", "standard_charge_dollar": 82.3, "additional_payer_notes": "80.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 102.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 102.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC All Payer (02-01-2023 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 121.35 }, { "payer_name": "UHC", "plan_name": "UHC Oxford (02-01-2023 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 121.35 }, { "payer_name": "UHC - Adhoc", "plan_name": "UHC - Adhoc All Payer", "methodology": "fee schedule", "standard_charge_dollar": 80.9 }, { "payer_name": "UHC - Adhoc", "plan_name": "UHC - Adhoc Oxford", "methodology": "fee schedule", "standard_charge_dollar": 80.9 }, { "payer_name": "Wellcare", "plan_name": "Wellcare Insurance Exchange", "methodology": "fee schedule", "standard_charge_dollar": 138.87, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 102.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup Medicare", "methodology": "fee schedule", "standard_charge_dollar": 102.87, "additional_payer_notes": "100.00% of Medicare Rates" } ] } ] }, { "description": "Hc Therapeutic Exercises Complex, Ea 15 Min", "code_information": [ { "code": "97110", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 150.97, "discounted_cash": 32.0, "minimum": 25.776, "maximum": 150.97, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 68.31, "additional_payer_notes": "212.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medical Rental Network", "methodology": "fee schedule", "standard_charge_dollar": 68.31, "additional_payer_notes": "212.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 32.22, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "ALLY-ALIGN (FKA SPARTAN PLAN NJ, INC.)", "plan_name": "ALLY-ALIGN (FKA SPARTAN PLAN NJ, INC.)", "methodology": "fee schedule", "standard_charge_dollar": 33.83, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Americhoice (UHC)", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 32.22, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Amerihealth", "plan_name": "Amerihealth Medicare", "methodology": "fee schedule", "standard_charge_dollar": 32.22, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 150.97, "additional_payer_notes": "A Indicator - 155.00% of Medicare Rates" }, { "payer_name": "Clover Health", "plan_name": "Clover Medicare", "methodology": "fee schedule", "standard_charge_dollar": 32.22, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Coventry", "plan_name": "Coventry Auto", "methodology": "fee schedule", "standard_charge_dollar": 64.44, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Coventry", "plan_name": "Coventry Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 64.44, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "fee schedule", "standard_charge_dollar": 45.11, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Fairprice Healthcare Holdings", "plan_name": "Fairprice Healthcare Holdings", "methodology": "fee schedule", "standard_charge_dollar": 51.55 }, { "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ HMO POS", "methodology": "fee schedule", "standard_charge_dollar": 106.58, "additional_payer_notes": "177.30% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ Indemnity", "methodology": "fee schedule", "standard_charge_dollar": 106.58, "additional_payer_notes": "177.30% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ PPO", "methodology": "fee schedule", "standard_charge_dollar": 106.58, "additional_payer_notes": "177.30% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon Medicare", "methodology": "fee schedule", "standard_charge_dollar": 32.22, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Military Tricare", "methodology": "fee schedule", "standard_charge_dollar": 25.78, "additional_payer_notes": "80.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 32.22, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 32.22, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC All Payer (02-01-2023 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 150.97 }, { "payer_name": "UHC", "plan_name": "UHC Oxford (02-01-2023 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 150.97 }, { "payer_name": "UHC - Adhoc", "plan_name": "UHC - Adhoc All Payer", "methodology": "fee schedule", "standard_charge_dollar": 150.97 }, { "payer_name": "UHC - Adhoc", "plan_name": "UHC - Adhoc Oxford", "methodology": "fee schedule", "standard_charge_dollar": 150.97 }, { "payer_name": "Wellcare", "plan_name": "Wellcare Insurance Exchange", "methodology": "fee schedule", "standard_charge_dollar": 43.5, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 32.22, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup Medicare", "methodology": "fee schedule", "standard_charge_dollar": 32.22, "additional_payer_notes": "100.00% of Medicare Rates" } ] } ] }, { "description": "Hc Ndsc Dcmprn 1 Ntrspc Lumbar", "code_information": [ { "code": "62380", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 34081.7, "discounted_cash": 8578.0, "minimum": 1715.0, "maximum": 27265.36, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 18186.06, "additional_payer_notes": "212.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medical Rental Network", "methodology": "fee schedule", "standard_charge_dollar": 18186.06, "additional_payer_notes": "212.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 8578.33, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "ALLY-ALIGN (FKA SPARTAN PLAN NJ, INC.)", "plan_name": "ALLY-ALIGN (FKA SPARTAN PLAN NJ, INC.)", "methodology": "fee schedule", "standard_charge_dollar": 9007.25, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Americhoice (UHC)", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 8578.33, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Amerihealth", "plan_name": "Amerihealth Medicare", "methodology": "fee schedule", "standard_charge_dollar": 8578.33, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 12605.86, "additional_payer_notes": "146.95% of Medicare Rates" }, { "payer_name": "Clover Health", "plan_name": "Clover Medicare", "methodology": "fee schedule", "standard_charge_dollar": 8578.33, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Coventry", "plan_name": "Coventry Auto", "methodology": "fee schedule", "standard_charge_dollar": 17156.66, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Coventry", "plan_name": "Coventry Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 17156.66, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "fee schedule", "standard_charge_dollar": 12009.66, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Fairprice Healthcare Holdings", "plan_name": "Fairprice Healthcare Holdings", "methodology": "fee schedule", "standard_charge_dollar": 13725.33, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ HMO POS", "methodology": "fee schedule", "standard_charge_dollar": 15209.38, "additional_payer_notes": "177.30% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ Indemnity", "methodology": "fee schedule", "standard_charge_dollar": 15209.38, "additional_payer_notes": "177.30% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ PPO", "methodology": "fee schedule", "standard_charge_dollar": 15209.38, "additional_payer_notes": "177.30% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon Medicare", "methodology": "fee schedule", "standard_charge_dollar": 8578.33, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Military Tricare", "methodology": "fee schedule", "standard_charge_dollar": 6862.66, "additional_payer_notes": "80.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 8578.33, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 8578.33, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC All Payer (02-01-2023 to 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 6624.0 }, { "payer_name": "UHC", "plan_name": "UHC Oxford (02-01-2023 to 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 6317.0 }, { "payer_name": "UHC - Adhoc", "plan_name": "UHC - Adhoc All Payer", "methodology": "case rate", "standard_charge_dollar": 7031.0 }, { "payer_name": "UHC - Adhoc", "plan_name": "UHC - Adhoc Oxford", "methodology": "case rate", "standard_charge_dollar": 6510.0 }, { "payer_name": "Wellcare", "plan_name": "Wellcare Insurance Exchange", "methodology": "fee schedule", "standard_charge_dollar": 11580.75, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 8578.33, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellchoice", "plan_name": "WELLCHOICE HMO of NJ (Empire) Commercial (HMO / HMO POS, PPO)", "methodology": "case rate", "standard_charge_dollar": 1715.0 }, { "payer_name": "Wellchoice", "plan_name": "WELLCHOICE HMO of NJ (Empire) Commercial (Indemnity)", "methodology": "case rate", "standard_charge_dollar": 1978.0 }, { "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup Medicare", "methodology": "fee schedule", "standard_charge_dollar": 8578.33, "additional_payer_notes": "100.00% of Medicare Rates" } ] } ] }, { "description": "Exc Face Les Sbq 2 Cm/>", "code_information": [ { "code": "21012", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 16929.0, "discounted_cash": 1952.0, "minimum": 1562.024, "maximum": 13543.2, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 4139.36, "additional_payer_notes": "212.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medical Rental Network", "methodology": "fee schedule", "standard_charge_dollar": 4139.36, "additional_payer_notes": "212.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1952.53, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "ALLY-ALIGN (FKA SPARTAN PLAN NJ, INC.)", "plan_name": "ALLY-ALIGN (FKA SPARTAN PLAN NJ, INC.)", "methodology": "fee schedule", "standard_charge_dollar": 2050.16, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Americhoice (UHC)", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1952.53, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Amerihealth", "plan_name": "Amerihealth Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1952.53, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 2869.24, "additional_payer_notes": "146.95% of Medicare Rates" }, { "payer_name": "Clover Health", "plan_name": "Clover Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1952.53, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Coventry", "plan_name": "Coventry Auto", "methodology": "fee schedule", "standard_charge_dollar": 3905.06, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Coventry", "plan_name": "Coventry Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 3905.06, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "fee schedule", "standard_charge_dollar": 2733.54, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Fairprice Healthcare Holdings", "plan_name": "Fairprice Healthcare Holdings", "methodology": "fee schedule", "standard_charge_dollar": 3124.05, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ HMO POS", "methodology": "fee schedule", "standard_charge_dollar": 3461.84, "additional_payer_notes": "177.30% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ Indemnity", "methodology": "fee schedule", "standard_charge_dollar": 3461.84, "additional_payer_notes": "177.30% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ PPO", "methodology": "fee schedule", "standard_charge_dollar": 3461.84, "additional_payer_notes": "177.30% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1952.53, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Military Tricare", "methodology": "fee schedule", "standard_charge_dollar": 1562.02, "additional_payer_notes": "80.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1952.53, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 1952.53, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC All Payer (02-01-2023 to 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 3147.0 }, { "payer_name": "UHC", "plan_name": "UHC Oxford (02-01-2023 to 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 2297.0 }, { "payer_name": "UHC - Adhoc", "plan_name": "UHC - Adhoc All Payer", "methodology": "case rate", "standard_charge_dollar": 3341.0 }, { "payer_name": "UHC - Adhoc", "plan_name": "UHC - Adhoc Oxford", "methodology": "case rate", "standard_charge_dollar": 2367.0 }, { "payer_name": "Wellcare", "plan_name": "Wellcare Insurance Exchange", "methodology": "fee schedule", "standard_charge_dollar": 2635.92, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1952.53, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellchoice", "plan_name": "WELLCHOICE HMO of NJ (Empire) Commercial (HMO / HMO POS, PPO)", "methodology": "case rate", "standard_charge_dollar": 1715.0 }, { "payer_name": "Wellchoice", "plan_name": "WELLCHOICE HMO of NJ (Empire) Commercial (Indemnity)", "methodology": "case rate", "standard_charge_dollar": 1978.0 }, { "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1952.53, "additional_payer_notes": "100.00% of Medicare Rates" } ] } ] }, { "description": "Hc Drug Screen Quantitative Levetiracetam", "code_information": [ { "code": "80177", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 299.0, "discounted_cash": 13.0, "minimum": 7.95, "maximum": 254.15, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 28.09, "additional_payer_notes": "212.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medical Rental Network", "methodology": "fee schedule", "standard_charge_dollar": 28.09, "additional_payer_notes": "212.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 13.25, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "ALLY-ALIGN (FKA SPARTAN PLAN NJ, INC.)", "plan_name": "ALLY-ALIGN (FKA SPARTAN PLAN NJ, INC.)", "methodology": "fee schedule", "standard_charge_dollar": 13.91, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Americhoice (UHC)", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 13.25, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Amerihealth", "plan_name": "Amerihealth Medicare", "methodology": "fee schedule", "standard_charge_dollar": 13.25, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 19.21, "additional_payer_notes": "Laboratory - 145.00% of Medicare Rates" }, { "payer_name": "Clover Health", "plan_name": "Clover Medicare", "methodology": "fee schedule", "standard_charge_dollar": 13.25, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Coventry", "plan_name": "Coventry Auto", "methodology": "fee schedule", "standard_charge_dollar": 26.5, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Coventry", "plan_name": "Coventry Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 26.5, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "fee schedule", "standard_charge_dollar": 18.55, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Fairprice Healthcare Holdings", "plan_name": "Fairprice Healthcare Holdings", "methodology": "fee schedule", "standard_charge_dollar": 15.9, "additional_payer_notes": "Laboratory - 120.00% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ HMO POS", "methodology": "fee schedule", "standard_charge_dollar": 211.09, "additional_payer_notes": "177.30% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ Indemnity", "methodology": "fee schedule", "standard_charge_dollar": 211.09, "additional_payer_notes": "177.30% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ PPO", "methodology": "fee schedule", "standard_charge_dollar": 211.09, "additional_payer_notes": "177.30% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon Medicare", "methodology": "fee schedule", "standard_charge_dollar": 13.25, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Military Tricare", "methodology": "fee schedule", "standard_charge_dollar": 10.6, "additional_payer_notes": "80.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 13.25, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 13.25, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC All Payer (02-01-2023 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 7.95 }, { "payer_name": "UHC", "plan_name": "UHC Medicaid (02/01/2023 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 10.6 }, { "payer_name": "UHC", "plan_name": "UHC Oxford (02-01-2023 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 7.95 }, { "payer_name": "UHC - Adhoc", "plan_name": "UHC - Adhoc All Payer", "methodology": "fee schedule", "standard_charge_dollar": 13.25 }, { "payer_name": "UHC - Adhoc", "plan_name": "UHC - Adhoc Oxford", "methodology": "fee schedule", "standard_charge_dollar": 13.25 }, { "payer_name": "Wellcare", "plan_name": "Wellcare Insurance Exchange", "methodology": "fee schedule", "standard_charge_dollar": 17.89, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 13.25, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup Medicaid", "methodology": "percent of total billed charges", "standard_charge_percentage": 19.09, "median_amount": 55.76, "10th_percentile": 13.25, "90th_percentile": 55.76, "count": "1 through 10" }, { "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup Medicare", "methodology": "fee schedule", "standard_charge_dollar": 13.25, "additional_payer_notes": "100.00% of Medicare Rates" } ] } ] }, { "description": "Hc M.Pneumon Dna Amp Probe", "code_information": [ { "code": "87581", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 194.95, "discounted_cash": 35.0, "minimum": 21.05, "maximum": 165.7075, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 74.39, "additional_payer_notes": "212.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medical Rental Network", "methodology": "fee schedule", "standard_charge_dollar": 74.39, "additional_payer_notes": "212.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 35.09, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "ALLY-ALIGN (FKA SPARTAN PLAN NJ, INC.)", "plan_name": "ALLY-ALIGN (FKA SPARTAN PLAN NJ, INC.)", "methodology": "fee schedule", "standard_charge_dollar": 36.84, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Americhoice (UHC)", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 35.09, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Amerihealth", "plan_name": "Amerihealth Medicare", "methodology": "fee schedule", "standard_charge_dollar": 35.09, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 50.88, "additional_payer_notes": "Laboratory - 145.00% of Medicare Rates" }, { "payer_name": "Clover Health", "plan_name": "Clover Medicare", "methodology": "fee schedule", "standard_charge_dollar": 35.09, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Coventry", "plan_name": "Coventry Auto", "methodology": "fee schedule", "standard_charge_dollar": 70.18, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Coventry", "plan_name": "Coventry Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 70.18, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "fee schedule", "standard_charge_dollar": 49.13, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Fairprice Healthcare Holdings", "plan_name": "Fairprice Healthcare Holdings", "methodology": "fee schedule", "standard_charge_dollar": 42.11, "additional_payer_notes": "Laboratory - 120.00% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ HMO POS", "methodology": "fee schedule", "standard_charge_dollar": 137.63, "additional_payer_notes": "177.30% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ Indemnity", "methodology": "fee schedule", "standard_charge_dollar": 137.63, "additional_payer_notes": "177.30% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ PPO", "methodology": "fee schedule", "standard_charge_dollar": 137.63, "additional_payer_notes": "177.30% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon Medicare", "methodology": "fee schedule", "standard_charge_dollar": 35.09, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Military Tricare", "methodology": "fee schedule", "standard_charge_dollar": 28.07, "additional_payer_notes": "80.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 35.09, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 35.09, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC All Payer (02-01-2023 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 21.05 }, { "payer_name": "UHC", "plan_name": "UHC Medicaid (02/01/2023 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 28.07 }, { "payer_name": "UHC", "plan_name": "UHC Oxford (02-01-2023 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 21.05 }, { "payer_name": "UHC - Adhoc", "plan_name": "UHC - Adhoc All Payer", "methodology": "fee schedule", "standard_charge_dollar": 35.09 }, { "payer_name": "UHC - Adhoc", "plan_name": "UHC - Adhoc Oxford", "methodology": "fee schedule", "standard_charge_dollar": 35.09 }, { "payer_name": "Wellcare", "plan_name": "Wellcare Insurance Exchange", "methodology": "fee schedule", "standard_charge_dollar": 47.37, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 35.09, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup Medicaid", "methodology": "percent of total billed charges", "standard_charge_percentage": 19.09, "median_amount": 37.22, "10th_percentile": 36.36, "90th_percentile": 37.22, "count": "1 through 10" }, { "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup Medicare", "methodology": "fee schedule", "standard_charge_dollar": 35.09, "additional_payer_notes": "100.00% of Medicare Rates" } ] } ] }, { "description": "Hc Clsd Treat Temporomandibl Disloc", "code_information": [ { "code": "21480", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 968.12, "discounted_cash": 291.0, "minimum": 184.8141, "maximum": 968.12, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 618.19, "additional_payer_notes": "212.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medical Rental Network", "methodology": "fee schedule", "standard_charge_dollar": 618.19, "additional_payer_notes": "212.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 291.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "ALLY-ALIGN (FKA SPARTAN PLAN NJ, INC.)", "plan_name": "ALLY-ALIGN (FKA SPARTAN PLAN NJ, INC.)", "methodology": "fee schedule", "standard_charge_dollar": 306.18, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Americhoice (UHC)", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 291.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Amerihealth", "plan_name": "Amerihealth Medicare", "methodology": "fee schedule", "standard_charge_dollar": 291.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 428.51, "additional_payer_notes": "146.95% of Medicare Rates" }, { "payer_name": "Clover Health", "plan_name": "Clover Medicare", "methodology": "fee schedule", "standard_charge_dollar": 291.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Coventry", "plan_name": "Coventry Auto", "methodology": "fee schedule", "standard_charge_dollar": 583.2, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Coventry", "plan_name": "Coventry Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 583.2, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "fee schedule", "standard_charge_dollar": 408.24, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Fairprice Healthcare Holdings", "plan_name": "Fairprice Healthcare Holdings", "methodology": "fee schedule", "standard_charge_dollar": 466.56, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ HMO POS", "methodology": "fee schedule", "standard_charge_dollar": 517.01, "additional_payer_notes": "177.30% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ Indemnity", "methodology": "fee schedule", "standard_charge_dollar": 517.01, "additional_payer_notes": "177.30% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ PPO", "methodology": "fee schedule", "standard_charge_dollar": 517.01, "additional_payer_notes": "177.30% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon Medicare", "methodology": "fee schedule", "standard_charge_dollar": 291.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Military Tricare", "methodology": "fee schedule", "standard_charge_dollar": 233.28, "additional_payer_notes": "80.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 291.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 291.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC All Payer (02-01-2023 to 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 968.12 }, { "payer_name": "UHC", "plan_name": "UHC Oxford (02-01-2023 to 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 968.12 }, { "payer_name": "UHC - Adhoc", "plan_name": "UHC - Adhoc All Payer", "methodology": "case rate", "standard_charge_dollar": 968.12 }, { "payer_name": "UHC - Adhoc", "plan_name": "UHC - Adhoc Oxford", "methodology": "case rate", "standard_charge_dollar": 968.12 }, { "payer_name": "Wellcare", "plan_name": "Wellcare Insurance Exchange", "methodology": "fee schedule", "standard_charge_dollar": 393.66, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 291.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup Medicare", "methodology": "fee schedule", "standard_charge_dollar": 291.6, "additional_payer_notes": "100.00% of Medicare Rates" } ] } ] }, { "description": "Hc Drain Ext Ear Absc/Blood,Simple", "code_information": [ { "code": "69000", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 2888.35, "discounted_cash": 837.0, "minimum": 551.386, "maximum": 2888.35, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 1774.76, "additional_payer_notes": "212.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medical Rental Network", "methodology": "fee schedule", "standard_charge_dollar": 1774.76, "additional_payer_notes": "212.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 837.15, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "ALLY-ALIGN (FKA SPARTAN PLAN NJ, INC.)", "plan_name": "ALLY-ALIGN (FKA SPARTAN PLAN NJ, INC.)", "methodology": "fee schedule", "standard_charge_dollar": 879.01, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Americhoice (UHC)", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 837.15, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Amerihealth", "plan_name": "Amerihealth Medicare", "methodology": "fee schedule", "standard_charge_dollar": 837.15, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 1230.19, "additional_payer_notes": "146.95% of Medicare Rates" }, { "payer_name": "Clover Health", "plan_name": "Clover Medicare", "methodology": "fee schedule", "standard_charge_dollar": 837.15, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Coventry", "plan_name": "Coventry Auto", "methodology": "fee schedule", "standard_charge_dollar": 1674.3, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Coventry", "plan_name": "Coventry Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 1674.3, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "fee schedule", "standard_charge_dollar": 1172.01, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Fairprice Healthcare Holdings", "plan_name": "Fairprice Healthcare Holdings", "methodology": "fee schedule", "standard_charge_dollar": 1339.44, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ HMO POS", "methodology": "fee schedule", "standard_charge_dollar": 1484.27, "additional_payer_notes": "177.30% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ Indemnity", "methodology": "fee schedule", "standard_charge_dollar": 1484.27, "additional_payer_notes": "177.30% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ PPO", "methodology": "fee schedule", "standard_charge_dollar": 1484.27, "additional_payer_notes": "177.30% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon Medicare", "methodology": "fee schedule", "standard_charge_dollar": 837.15, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Military Tricare", "methodology": "fee schedule", "standard_charge_dollar": 669.72, "additional_payer_notes": "80.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 837.15, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 837.15, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC All Payer (02-01-2023 to 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 2888.35 }, { "payer_name": "UHC", "plan_name": "UHC Oxford (02-01-2023 to 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 2297.0 }, { "payer_name": "UHC - Adhoc", "plan_name": "UHC - Adhoc All Payer", "methodology": "case rate", "standard_charge_dollar": 2888.35 }, { "payer_name": "UHC - Adhoc", "plan_name": "UHC - Adhoc Oxford", "methodology": "case rate", "standard_charge_dollar": 2367.0 }, { "payer_name": "Wellcare", "plan_name": "Wellcare Insurance Exchange", "methodology": "fee schedule", "standard_charge_dollar": 1130.15, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 837.15, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellchoice", "plan_name": "WELLCHOICE HMO of NJ (Empire) Commercial (HMO / HMO POS, PPO)", "methodology": "case rate", "standard_charge_dollar": 1715.0 }, { "payer_name": "Wellchoice", "plan_name": "WELLCHOICE HMO of NJ (Empire) Commercial (Indemnity)", "methodology": "case rate", "standard_charge_dollar": 1978.0 }, { "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup Medicare", "methodology": "fee schedule", "standard_charge_dollar": 837.15, "additional_payer_notes": "100.00% of Medicare Rates" } ] } ] }, { "description": "CARDIOMYOPATHY - SOI : 1", "code_information": [ { "code": "2051", "type": "APR-DRG" } ], "standard_charges": [ { "setting": "inpatient", "minimum": 6063.63, "maximum": 6669.99, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Better Health - Medi Medi", "methodology": "case rate", "standard_charge_dollar": 6669.99, "additional_payer_notes": "110% of State Medicaid Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Better Health Medicaid", "methodology": "case rate", "standard_charge_dollar": 6669.99, "additional_payer_notes": "110% of State Medicaid Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "case rate", "standard_charge_dollar": 6063.63, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "UBH", "plan_name": "UBH Medicaid", "methodology": "case rate", "standard_charge_dollar": 6063.63, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicaid (02/01/2023 to 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 6184.9, "additional_payer_notes": "102% of State Medicaid Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicaid", "methodology": "case rate", "standard_charge_dollar": 6063.63, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup Medicaid", "methodology": "case rate", "standard_charge_dollar": 6063.63, "additional_payer_notes": "100% of State Medicaid Rates" } ] } ] }, { "description": "Hc Radex Spine Cervical 6 Or More Views", "code_information": [ { "code": "72052", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 851.86, "discounted_cash": 123.0, "minimum": 96.72, "maximum": 724.081, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 262.01, "additional_payer_notes": "212.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medical Rental Network", "methodology": "fee schedule", "standard_charge_dollar": 262.01, "additional_payer_notes": "212.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 123.59, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "ALLY-ALIGN (FKA SPARTAN PLAN NJ, INC.)", "plan_name": "ALLY-ALIGN (FKA SPARTAN PLAN NJ, INC.)", "methodology": "fee schedule", "standard_charge_dollar": 129.77, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Americhoice (UHC)", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 123.59, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Amerihealth", "plan_name": "Amerihealth HMO", "methodology": "fee schedule", "standard_charge_dollar": 96.72 }, { "payer_name": "Amerihealth", "plan_name": "Amerihealth Medicare", "methodology": "fee schedule", "standard_charge_dollar": 123.59, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 181.62, "additional_payer_notes": "146.95% of Medicare Rates" }, { "payer_name": "Clover Health", "plan_name": "Clover Medicare", "methodology": "fee schedule", "standard_charge_dollar": 123.59, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Coventry", "plan_name": "Coventry Auto", "methodology": "fee schedule", "standard_charge_dollar": 247.18, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Coventry", "plan_name": "Coventry Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 247.18, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "fee schedule", "standard_charge_dollar": 173.03, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Fairprice Healthcare Holdings", "plan_name": "Fairprice Healthcare Holdings", "methodology": "fee schedule", "standard_charge_dollar": 197.74, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ HMO POS", "methodology": "fee schedule", "standard_charge_dollar": 219.13, "additional_payer_notes": "177.30% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ Indemnity", "methodology": "fee schedule", "standard_charge_dollar": 219.13, "additional_payer_notes": "177.30% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ PPO", "methodology": "fee schedule", "standard_charge_dollar": 219.13, "additional_payer_notes": "177.30% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon Medicare", "methodology": "fee schedule", "standard_charge_dollar": 123.59, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon NJ Health Medicaid", "methodology": "percent of total billed charges", "standard_charge_percentage": 19.58, "median_amount": 166.79, "10th_percentile": 166.79, "90th_percentile": 166.79, "count": "1 through 10" }, { "payer_name": "Humana", "plan_name": "Humana Military Tricare", "methodology": "fee schedule", "standard_charge_dollar": 98.87, "additional_payer_notes": "80.00% of Medicare Rates" }, { "payer_name": "Keenan", "plan_name": "Keenan", "methodology": "percent of total billed charges", "standard_charge_percentage": 30.0, "median_amount": 488.66, "10th_percentile": 488.66, "90th_percentile": 488.66, "count": "1 through 10" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 123.59, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 123.59, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC All Payer (02-01-2023 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 163.46 }, { "payer_name": "UHC", "plan_name": "UHC Oxford (02-01-2023 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 163.46 }, { "payer_name": "UHC - Adhoc", "plan_name": "UHC - Adhoc All Payer", "methodology": "fee schedule", "standard_charge_dollar": 108.97 }, { "payer_name": "UHC - Adhoc", "plan_name": "UHC - Adhoc Oxford", "methodology": "fee schedule", "standard_charge_dollar": 108.97 }, { "payer_name": "Wellcare", "plan_name": "Wellcare Insurance Exchange", "methodology": "fee schedule", "standard_charge_dollar": 166.85, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 123.59, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup Medicare", "methodology": "fee schedule", "standard_charge_dollar": 123.59, "additional_payer_notes": "100.00% of Medicare Rates" } ] } ] }, { "description": "Hc Us,Pregnant Uterus,F/U,Transabd App", "code_information": [ { "code": "76816", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 451.31, "discounted_cash": 123.0, "minimum": 86.1551, "maximum": 383.6135, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 262.01, "additional_payer_notes": "212.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medical Rental Network", "methodology": "fee schedule", "standard_charge_dollar": 262.01, "additional_payer_notes": "212.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 123.59, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "ALLY-ALIGN (FKA SPARTAN PLAN NJ, INC.)", "plan_name": "ALLY-ALIGN (FKA SPARTAN PLAN NJ, INC.)", "methodology": "fee schedule", "standard_charge_dollar": 129.77, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Americhoice (UHC)", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 123.59, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Amerihealth", "plan_name": "Amerihealth HMO", "methodology": "fee schedule", "standard_charge_dollar": 114.45 }, { "payer_name": "Amerihealth", "plan_name": "Amerihealth Medicare", "methodology": "fee schedule", "standard_charge_dollar": 123.59, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 181.62, "additional_payer_notes": "146.95% of Medicare Rates" }, { "payer_name": "Clover Health", "plan_name": "Clover Medicare", "methodology": "fee schedule", "standard_charge_dollar": 123.59, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Coventry", "plan_name": "Coventry Auto", "methodology": "fee schedule", "standard_charge_dollar": 247.18, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Coventry", "plan_name": "Coventry Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 247.18, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "fee schedule", "standard_charge_dollar": 173.03, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Fairprice Healthcare Holdings", "plan_name": "Fairprice Healthcare Holdings", "methodology": "fee schedule", "standard_charge_dollar": 197.74, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ HMO POS", "methodology": "fee schedule", "standard_charge_dollar": 219.13, "additional_payer_notes": "177.30% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ Indemnity", "methodology": "fee schedule", "standard_charge_dollar": 219.13, "additional_payer_notes": "177.30% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ PPO", "methodology": "fee schedule", "standard_charge_dollar": 219.13, "additional_payer_notes": "177.30% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon Medicare", "methodology": "fee schedule", "standard_charge_dollar": 123.59, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Military Tricare", "methodology": "fee schedule", "standard_charge_dollar": 98.87, "additional_payer_notes": "80.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 123.59, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 123.59, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC All Payer (02-01-2023 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 163.46 }, { "payer_name": "UHC", "plan_name": "UHC Oxford (02-01-2023 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 163.46 }, { "payer_name": "UHC - Adhoc", "plan_name": "UHC - Adhoc All Payer", "methodology": "fee schedule", "standard_charge_dollar": 108.97 }, { "payer_name": "UHC - Adhoc", "plan_name": "UHC - Adhoc Oxford", "methodology": "fee schedule", "standard_charge_dollar": 108.97 }, { "payer_name": "Wellcare", "plan_name": "Wellcare Insurance Exchange", "methodology": "fee schedule", "standard_charge_dollar": 166.85, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 123.59, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup Medicare", "methodology": "fee schedule", "standard_charge_dollar": 123.59, "additional_payer_notes": "100.00% of Medicare Rates" } ] } ] }, { "description": "LYMPHOMA AND NON-ACUTE LEUKEMIA WITH CC", "code_information": [ { "code": "841", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 20409.0, "minimum": 10208.24, "maximum": 36942.0095, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "case rate", "standard_charge_dollar": 36942.01, "additional_payer_notes": "181.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medical Rental Network", "methodology": "case rate", "standard_charge_dollar": 36942.01, "additional_payer_notes": "181.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "case rate", "standard_charge_dollar": 16695.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "ALLY-ALIGN (FKA SPARTAN PLAN NJ, INC.)", "plan_name": "ALLY-ALIGN (FKA SPARTAN PLAN NJ, INC.)", "methodology": "case rate", "standard_charge_dollar": 21430.45, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Americhoice (UHC)", "plan_name": "UHC Medicare", "methodology": "case rate", "standard_charge_dollar": 16695.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Amerihealth", "plan_name": "Amerihealth Medicare", "methodology": "case rate", "standard_charge_dollar": 16695.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Commercial", "methodology": "case rate", "standard_charge_dollar": 23867.38 }, { "payer_name": "Clover Health", "plan_name": "Clover Medicare", "methodology": "case rate", "standard_charge_dollar": 16695.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Coventry", "plan_name": "Coventry Auto", "methodology": "case rate", "standard_charge_dollar": 34696.92, "additional_payer_notes": "170.00% of Medicare Rates" }, { "payer_name": "Coventry", "plan_name": "Coventry Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 34696.92, "additional_payer_notes": "170.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "case rate", "standard_charge_dollar": 26532.94, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Fairprice Healthcare Holdings", "plan_name": "Fairprice Healthcare Holdings", "methodology": "case rate", "standard_charge_dollar": 32655.92, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon Medicare", "methodology": "case rate", "standard_charge_dollar": 16695.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon NJ Health Medicaid", "methodology": "case rate", "standard_charge_dollar": 10208.24 }, { "payer_name": "Humana", "plan_name": "Humana Military Tricare", "methodology": "case rate", "standard_charge_dollar": 16327.96, "additional_payer_notes": "80.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 20409.95, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 20253.1 }, { "payer_name": "UBH", "plan_name": "UBH Medicare", "methodology": "case rate", "standard_charge_dollar": 16695.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC All Payer (02-01-2023 to 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 27498.88 }, { "payer_name": "UHC", "plan_name": "UHC Oxford (02-01-2023 to 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 23965.27 }, { "payer_name": "UHC - Adhoc", "plan_name": "UHC - Adhoc All Payer", "methodology": "case rate", "standard_charge_dollar": 29190.64 }, { "payer_name": "UHC - Adhoc", "plan_name": "UHC - Adhoc Oxford", "methodology": "case rate", "standard_charge_dollar": 24696.13 }, { "payer_name": "Wellcare", "plan_name": "Wellcare Insurance Exchange", "methodology": "case rate", "standard_charge_dollar": 27553.43, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "case rate", "standard_charge_dollar": 16695.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup Medicare", "methodology": "case rate", "standard_charge_dollar": 16695.3, "additional_payer_notes": "100.00% of Medicare Rates" } ] } ] }, { "description": "FRACTURE OF PELVIS OR DISLOCATION OF HIP - SOI : 2", "code_information": [ { "code": "3412", "type": "APR-DRG" } ], "standard_charges": [ { "setting": "inpatient", "minimum": 7748.34, "maximum": 8523.18, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Better Health - Medi Medi", "methodology": "case rate", "standard_charge_dollar": 8523.18, "additional_payer_notes": "110% of State Medicaid Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Better Health Medicaid", "methodology": "case rate", "standard_charge_dollar": 8523.18, "additional_payer_notes": "110% of State Medicaid Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "case rate", "standard_charge_dollar": 7748.34, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "UBH", "plan_name": "UBH Medicaid", "methodology": "case rate", "standard_charge_dollar": 7748.34, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicaid (02/01/2023 to 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 7903.31, "additional_payer_notes": "102% of State Medicaid Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicaid", "methodology": "case rate", "standard_charge_dollar": 7748.34, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup Medicaid", "methodology": "case rate", "standard_charge_dollar": 7748.34, "additional_payer_notes": "100% of State Medicaid Rates" } ] } ] }, { "description": "Hc Withdrawal Of Arterial Blood", "code_information": [ { "code": "36600", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 524.41, "discounted_cash": 157.0, "minimum": 100.1099, "maximum": 524.41, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 333.45, "additional_payer_notes": "212.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medical Rental Network", "methodology": "fee schedule", "standard_charge_dollar": 333.45, "additional_payer_notes": "212.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 157.29, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "ALLY-ALIGN (FKA SPARTAN PLAN NJ, INC.)", "plan_name": "ALLY-ALIGN (FKA SPARTAN PLAN NJ, INC.)", "methodology": "fee schedule", "standard_charge_dollar": 165.15, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Americhoice (UHC)", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 157.29, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Amerihealth", "plan_name": "Amerihealth Medicare", "methodology": "fee schedule", "standard_charge_dollar": 157.29, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 231.14, "additional_payer_notes": "146.95% of Medicare Rates" }, { "payer_name": "Clover Health", "plan_name": "Clover Medicare", "methodology": "fee schedule", "standard_charge_dollar": 157.29, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Coventry", "plan_name": "Coventry Auto", "methodology": "fee schedule", "standard_charge_dollar": 314.58, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Coventry", "plan_name": "Coventry Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 314.58, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "fee schedule", "standard_charge_dollar": 220.21, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Fairprice Healthcare Holdings", "plan_name": "Fairprice Healthcare Holdings", "methodology": "fee schedule", "standard_charge_dollar": 251.66, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ HMO POS", "methodology": "fee schedule", "standard_charge_dollar": 278.88, "additional_payer_notes": "177.30% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ Indemnity", "methodology": "fee schedule", "standard_charge_dollar": 278.88, "additional_payer_notes": "177.30% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ PPO", "methodology": "fee schedule", "standard_charge_dollar": 278.88, "additional_payer_notes": "177.30% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon Medicare", "methodology": "fee schedule", "standard_charge_dollar": 157.29, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon NJ Health Medicaid", "methodology": "percent of total billed charges", "standard_charge_percentage": 19.58, "median_amount": 102.68, "10th_percentile": 96.14, "90th_percentile": 102.68, "count": "14" }, { "payer_name": "Humana", "plan_name": "Humana Military Tricare", "methodology": "fee schedule", "standard_charge_dollar": 125.83, "additional_payer_notes": "80.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 157.29, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 157.29, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC All Payer (02-01-2023 to 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 524.41 }, { "payer_name": "UHC", "plan_name": "UHC Medicaid (02/01/2023 to 12-31-2026)", "methodology": "percent of total billed charges", "standard_charge_percentage": 19.47, "median_amount": 99.76, "10th_percentile": 99.76, "90th_percentile": 99.76, "count": "1 through 10" }, { "payer_name": "UHC", "plan_name": "UHC Oxford (02-01-2023 to 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 524.41 }, { "payer_name": "UHC - Adhoc", "plan_name": "UHC - Adhoc All Payer", "methodology": "case rate", "standard_charge_dollar": 524.41 }, { "payer_name": "UHC - Adhoc", "plan_name": "UHC - Adhoc Oxford", "methodology": "case rate", "standard_charge_dollar": 524.41 }, { "payer_name": "Wellcare", "plan_name": "Wellcare Insurance Exchange", "methodology": "fee schedule", "standard_charge_dollar": 212.34, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 157.29, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup Medicaid", "methodology": "percent of total billed charges", "standard_charge_percentage": 19.09, "median_amount": 97.8, "10th_percentile": 97.8, "90th_percentile": 195.6, "count": "1 through 10" }, { "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup Medicare", "methodology": "fee schedule", "standard_charge_dollar": 157.29, "additional_payer_notes": "100.00% of Medicare Rates" } ] } ] }, { "description": "EXTRACRANIAL PROCEDURES WITH CC", "code_information": [ { "code": "038", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 20308.0, "minimum": 10438.65, "maximum": 36757.9325, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "case rate", "standard_charge_dollar": 36757.93, "additional_payer_notes": "181.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medical Rental Network", "methodology": "case rate", "standard_charge_dollar": 36757.93, "additional_payer_notes": "181.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "case rate", "standard_charge_dollar": 16613.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "ALLY-ALIGN (FKA SPARTAN PLAN NJ, INC.)", "plan_name": "ALLY-ALIGN (FKA SPARTAN PLAN NJ, INC.)", "methodology": "case rate", "standard_charge_dollar": 21323.66, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Americhoice (UHC)", "plan_name": "UHC Medicare", "methodology": "case rate", "standard_charge_dollar": 16613.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Amerihealth", "plan_name": "Amerihealth Medicare", "methodology": "case rate", "standard_charge_dollar": 16613.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Commercial", "methodology": "case rate", "standard_charge_dollar": 23738.64 }, { "payer_name": "Clover Health", "plan_name": "Clover Medicare", "methodology": "case rate", "standard_charge_dollar": 16613.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Coventry", "plan_name": "Coventry Auto", "methodology": "case rate", "standard_charge_dollar": 34524.03, "additional_payer_notes": "170.00% of Medicare Rates" }, { "payer_name": "Coventry", "plan_name": "Coventry Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 34524.03, "additional_payer_notes": "170.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "case rate", "standard_charge_dollar": 26400.73, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Fairprice Healthcare Holdings", "plan_name": "Fairprice Healthcare Holdings", "methodology": "case rate", "standard_charge_dollar": 32493.2, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon Medicare", "methodology": "case rate", "standard_charge_dollar": 16613.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon NJ Health Medicaid", "methodology": "case rate", "standard_charge_dollar": 10438.65 }, { "payer_name": "Humana", "plan_name": "Humana Military Tricare", "methodology": "case rate", "standard_charge_dollar": 16246.6, "additional_payer_notes": "80.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 20308.25, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 26262.7 }, { "payer_name": "UBH", "plan_name": "UBH Medicare", "methodology": "case rate", "standard_charge_dollar": 16613.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC All Payer (02-01-2023 to 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 27350.55 }, { "payer_name": "UHC", "plan_name": "UHC Oxford (02-01-2023 to 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 23835.99 }, { "payer_name": "UHC - Adhoc", "plan_name": "UHC - Adhoc All Payer", "methodology": "case rate", "standard_charge_dollar": 29033.18 }, { "payer_name": "UHC - Adhoc", "plan_name": "UHC - Adhoc Oxford", "methodology": "case rate", "standard_charge_dollar": 24562.92 }, { "payer_name": "Wellcare", "plan_name": "Wellcare Insurance Exchange", "methodology": "case rate", "standard_charge_dollar": 27416.14, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "case rate", "standard_charge_dollar": 16613.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup Medicare", "methodology": "case rate", "standard_charge_dollar": 16613.7, "additional_payer_notes": "100.00% of Medicare Rates" } ] } ] }, { "description": "Hc Assay Of Phenothiazine - 80342 - 30100385", "code_information": [ { "code": "80342", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 46.0, "minimum": 8.7814, "maximum": 39.1, "payers_information": [ { "payer_name": "UHC", "plan_name": "UHC Medicaid (02/01/2023 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 16.48 } ] } ] }, { "description": "Hc Phenotype Dna Hiv W/Clt, Ea Add", "code_information": [ { "code": "87904", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 606.0, "discounted_cash": 26.0, "minimum": 15.64, "maximum": 515.1, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 55.27, "additional_payer_notes": "212.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medical Rental Network", "methodology": "fee schedule", "standard_charge_dollar": 55.27, "additional_payer_notes": "212.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 26.07, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "ALLY-ALIGN (FKA SPARTAN PLAN NJ, INC.)", "plan_name": "ALLY-ALIGN (FKA SPARTAN PLAN NJ, INC.)", "methodology": "fee schedule", "standard_charge_dollar": 27.37, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Americhoice (UHC)", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 26.07, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Amerihealth", "plan_name": "Amerihealth Medicare", "methodology": "fee schedule", "standard_charge_dollar": 26.07, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 37.8, "additional_payer_notes": "Laboratory - 145.00% of Medicare Rates" }, { "payer_name": "Clover Health", "plan_name": "Clover Medicare", "methodology": "fee schedule", "standard_charge_dollar": 26.07, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Coventry", "plan_name": "Coventry Auto", "methodology": "fee schedule", "standard_charge_dollar": 52.14, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Coventry", "plan_name": "Coventry Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 52.14, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "fee schedule", "standard_charge_dollar": 36.5, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Fairprice Healthcare Holdings", "plan_name": "Fairprice Healthcare Holdings", "methodology": "fee schedule", "standard_charge_dollar": 31.28, "additional_payer_notes": "Laboratory - 120.00% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ HMO POS", "methodology": "fee schedule", "standard_charge_dollar": 427.84, "additional_payer_notes": "177.30% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ Indemnity", "methodology": "fee schedule", "standard_charge_dollar": 427.84, "additional_payer_notes": "177.30% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ PPO", "methodology": "fee schedule", "standard_charge_dollar": 427.84, "additional_payer_notes": "177.30% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon Medicare", "methodology": "fee schedule", "standard_charge_dollar": 26.07, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Military Tricare", "methodology": "fee schedule", "standard_charge_dollar": 20.86, "additional_payer_notes": "80.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 26.07, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 26.07, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC All Payer (02-01-2023 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 15.64 }, { "payer_name": "UHC", "plan_name": "UHC Medicaid (02/01/2023 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 20.86 }, { "payer_name": "UHC", "plan_name": "UHC Oxford (02-01-2023 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 15.64 }, { "payer_name": "UHC - Adhoc", "plan_name": "UHC - Adhoc All Payer", "methodology": "fee schedule", "standard_charge_dollar": 26.07 }, { "payer_name": "UHC - Adhoc", "plan_name": "UHC - Adhoc Oxford", "methodology": "fee schedule", "standard_charge_dollar": 26.07 }, { "payer_name": "Wellcare", "plan_name": "Wellcare Insurance Exchange", "methodology": "fee schedule", "standard_charge_dollar": 35.19, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 26.07, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup Medicare", "methodology": "fee schedule", "standard_charge_dollar": 26.07, "additional_payer_notes": "100.00% of Medicare Rates" } ] } ] }, { "description": "TRACHEOSTOMY W MV 96+ HOURS W EXTENSIVE PROCEDURE - SOI : 4", "code_information": [ { "code": "0044", "type": "APR-DRG" } ], "standard_charges": [ { "setting": "inpatient", "minimum": 195022.5, "maximum": 214524.75, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Better Health - Medi Medi", "methodology": "case rate", "standard_charge_dollar": 214524.75, "additional_payer_notes": "110% of State Medicaid Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Better Health Medicaid", "methodology": "case rate", "standard_charge_dollar": 214524.75, "additional_payer_notes": "110% of State Medicaid Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "case rate", "standard_charge_dollar": 195022.5, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "UBH", "plan_name": "UBH Medicaid", "methodology": "case rate", "standard_charge_dollar": 195022.5, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicaid (02/01/2023 to 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 198922.95, "additional_payer_notes": "102% of State Medicaid Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicaid", "methodology": "case rate", "standard_charge_dollar": 195022.5, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup Medicaid", "methodology": "case rate", "standard_charge_dollar": 195022.5, "additional_payer_notes": "100% of State Medicaid Rates" } ] } ] }, { "description": "TRANSURETHRAL PROSTATECTOMY - SOI : 4", "code_information": [ { "code": "4824", "type": "APR-DRG" } ], "standard_charges": [ { "setting": "inpatient", "minimum": 34142.52, "maximum": 37556.77, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Better Health - Medi Medi", "methodology": "case rate", "standard_charge_dollar": 37556.77, "additional_payer_notes": "110% of State Medicaid Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Better Health Medicaid", "methodology": "case rate", "standard_charge_dollar": 37556.77, "additional_payer_notes": "110% of State Medicaid Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "case rate", "standard_charge_dollar": 34142.52, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "UBH", "plan_name": "UBH Medicaid", "methodology": "case rate", "standard_charge_dollar": 34142.52, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicaid (02/01/2023 to 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 34825.37, "additional_payer_notes": "102% of State Medicaid Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicaid", "methodology": "case rate", "standard_charge_dollar": 34142.52, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup Medicaid", "methodology": "case rate", "standard_charge_dollar": 34142.52, "additional_payer_notes": "100% of State Medicaid Rates" } ] } ] }, { "description": "Hc Assay Of Barbiturates - 80345 - 30100326", "code_information": [ { "code": "80345", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 58.0, "minimum": 11.0722, "maximum": 49.3, "payers_information": [ { "payer_name": "UHC", "plan_name": "UHC Medicaid (02/01/2023 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 22.05 } ] } ] }, { "description": "PANCREAS TRANSPLANT", "code_information": [ { "code": "010", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 84482.0, "minimum": 28186.3, "maximum": 152913.2888, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "case rate", "standard_charge_dollar": 152913.29, "additional_payer_notes": "181.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medical Rental Network", "methodology": "case rate", "standard_charge_dollar": 152913.29, "additional_payer_notes": "181.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "case rate", "standard_charge_dollar": 68143.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "ALLY-ALIGN (FKA SPARTAN PLAN NJ, INC.)", "plan_name": "ALLY-ALIGN (FKA SPARTAN PLAN NJ, INC.)", "methodology": "case rate", "standard_charge_dollar": 88706.6, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Americhoice (UHC)", "plan_name": "UHC Medicare", "methodology": "case rate", "standard_charge_dollar": 68143.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Amerihealth", "plan_name": "Amerihealth Medicare", "methodology": "case rate", "standard_charge_dollar": 68143.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Commercial", "methodology": "case rate", "standard_charge_dollar": 104980.49 }, { "payer_name": "Clover Health", "plan_name": "Clover Medicare", "methodology": "case rate", "standard_charge_dollar": 68143.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Coventry", "plan_name": "Coventry Auto", "methodology": "case rate", "standard_charge_dollar": 143620.22, "additional_payer_notes": "170.00% of Medicare Rates" }, { "payer_name": "Coventry", "plan_name": "Coventry Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 143620.22, "additional_payer_notes": "170.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "case rate", "standard_charge_dollar": 109827.22, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Fairprice Healthcare Holdings", "plan_name": "Fairprice Healthcare Holdings", "methodology": "case rate", "standard_charge_dollar": 135171.97, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon Medicare", "methodology": "case rate", "standard_charge_dollar": 68143.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon NJ Health Medicaid", "methodology": "case rate", "standard_charge_dollar": 28186.3 }, { "payer_name": "Humana", "plan_name": "Humana Military Tricare", "methodology": "case rate", "standard_charge_dollar": 67585.98, "additional_payer_notes": "80.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 84482.48, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 115998.0 }, { "payer_name": "UBH", "plan_name": "UBH Medicare", "methodology": "case rate", "standard_charge_dollar": 68143.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC All Payer (02-01-2023 to 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 120953.6 }, { "payer_name": "UHC", "plan_name": "UHC Oxford (02-01-2023 to 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 105411.03 }, { "payer_name": "UHC - Adhoc", "plan_name": "UHC - Adhoc All Payer", "methodology": "case rate", "standard_charge_dollar": 128394.8 }, { "payer_name": "UHC - Adhoc", "plan_name": "UHC - Adhoc Oxford", "methodology": "case rate", "standard_charge_dollar": 108625.75 }, { "payer_name": "Wellcare", "plan_name": "Wellcare Insurance Exchange", "methodology": "case rate", "standard_charge_dollar": 114051.35, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "case rate", "standard_charge_dollar": 68143.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup Medicare", "methodology": "case rate", "standard_charge_dollar": 68143.8, "additional_payer_notes": "100.00% of Medicare Rates" } ] } ] }, { "description": "NON-ELECTIVE OR COMPLEX KNEE JOINT REPLACEMENT- SOI : 3", "code_information": [ { "code": "3253", "type": "APR-DRG" } ], "standard_charges": [ { "setting": "inpatient", "minimum": 39390.18, "maximum": 43329.2, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Better Health - Medi Medi", "methodology": "case rate", "standard_charge_dollar": 43329.2, "additional_payer_notes": "110% of State Medicaid Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Better Health Medicaid", "methodology": "case rate", "standard_charge_dollar": 43329.2, "additional_payer_notes": "110% of State Medicaid Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "case rate", "standard_charge_dollar": 39390.18, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "UBH", "plan_name": "UBH Medicaid", "methodology": "case rate", "standard_charge_dollar": 39390.18, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicaid (02/01/2023 to 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 40177.98, "additional_payer_notes": "102% of State Medicaid Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicaid", "methodology": "case rate", "standard_charge_dollar": 39390.18, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup Medicaid", "methodology": "case rate", "standard_charge_dollar": 39390.18, "additional_payer_notes": "100% of State Medicaid Rates" } ] } ] }, { "description": "Hc (Sup Shell A4556) Electrodes, Pair", "code_information": [ { "code": "A4556", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "payers_information": [ { "payer_name": "Horizon", "plan_name": "Horizon NJ Health Medicaid", "methodology": "percent of total billed charges", "standard_charge_percentage": 19.58, "median_amount": 127.4, "10th_percentile": 127.4, "90th_percentile": 127.4, "count": "1 through 10" }, { "payer_name": "UHC", "plan_name": "UHC Medicaid (02/01/2023 to 12-31-2026)", "methodology": "percent of total billed charges", "standard_charge_percentage": 19.47, "median_amount": 123.78, "10th_percentile": 123.78, "90th_percentile": 123.78, "count": "1 through 10" } ] } ] }, { "description": "APPENDECTOMY WITH COMPLEX PRINCIPAL DIAGNOSIS - SOI : 3", "code_information": [ { "code": "2333", "type": "APR-DRG" } ], "standard_charges": [ { "setting": "inpatient", "minimum": 23555.73, "maximum": 25911.31, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Better Health - Medi Medi", "methodology": "case rate", "standard_charge_dollar": 25911.31, "additional_payer_notes": "110% of State Medicaid Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Better Health Medicaid", "methodology": "case rate", "standard_charge_dollar": 25911.31, "additional_payer_notes": "110% of State Medicaid Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "case rate", "standard_charge_dollar": 23555.73, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "UBH", "plan_name": "UBH Medicaid", "methodology": "case rate", "standard_charge_dollar": 23555.73, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicaid (02/01/2023 to 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 24026.85, "additional_payer_notes": "102% of State Medicaid Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicaid", "methodology": "case rate", "standard_charge_dollar": 23555.73, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup Medicaid", "methodology": "case rate", "standard_charge_dollar": 23555.73, "additional_payer_notes": "100% of State Medicaid Rates" } ] } ] }, { "description": "MALIGNANCY, MALE REPRODUCTIVE SYSTEM WITHOUT CCMCC", "code_information": [ { "code": "724", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 9134.0, "minimum": 4303.6, "maximum": 16533.083, "payers_information": [ { "payer_name": "Coventry", "plan_name": "Coventry Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 15528.31, "additional_payer_notes": "170.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "case rate", "standard_charge_dollar": 11874.59, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Fairprice Healthcare Holdings", "plan_name": "Fairprice Healthcare Holdings", "methodology": "case rate", "standard_charge_dollar": 14614.88, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon Medicare", "methodology": "case rate", "standard_charge_dollar": 7641.31, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon NJ Health Medicaid", "methodology": "case rate", "standard_charge_dollar": 4303.6 }, { "payer_name": "Humana", "plan_name": "Humana Military Tricare", "methodology": "case rate", "standard_charge_dollar": 7307.44, "additional_payer_notes": "80.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 9134.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 10599.7 }, { "payer_name": "UBH", "plan_name": "UBH Medicare", "methodology": "case rate", "standard_charge_dollar": 7641.31, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC All Payer (02-01-2023 to 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 11052.48 }, { "payer_name": "UHC", "plan_name": "UHC Oxford (02-01-2023 to 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 9632.23 }, { "payer_name": "UHC - Adhoc", "plan_name": "UHC - Adhoc All Payer", "methodology": "case rate", "standard_charge_dollar": 11732.44 }, { "payer_name": "UHC - Adhoc", "plan_name": "UHC - Adhoc Oxford", "methodology": "case rate", "standard_charge_dollar": 9925.99 }, { "payer_name": "Wellcare", "plan_name": "Wellcare Insurance Exchange", "methodology": "case rate", "standard_charge_dollar": 12331.31, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "case rate", "standard_charge_dollar": 7641.31, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup Medicare", "methodology": "case rate", "standard_charge_dollar": 7641.31, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "case rate", "standard_charge_dollar": 16533.08, "additional_payer_notes": "181.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medical Rental Network", "methodology": "case rate", "standard_charge_dollar": 16533.08, "additional_payer_notes": "181.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "case rate", "standard_charge_dollar": 7641.31, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "ALLY-ALIGN (FKA SPARTAN PLAN NJ, INC.)", "plan_name": "ALLY-ALIGN (FKA SPARTAN PLAN NJ, INC.)", "methodology": "case rate", "standard_charge_dollar": 9591.02, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Americhoice (UHC)", "plan_name": "UHC Medicare", "methodology": "case rate", "standard_charge_dollar": 7641.31, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Amerihealth", "plan_name": "Amerihealth Medicare", "methodology": "case rate", "standard_charge_dollar": 7641.31, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Commercial", "methodology": "case rate", "standard_charge_dollar": 9592.89 }, { "payer_name": "Clover Health", "plan_name": "Clover Medicare", "methodology": "case rate", "standard_charge_dollar": 7641.31, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Coventry", "plan_name": "Coventry Auto", "methodology": "case rate", "standard_charge_dollar": 15528.31, "additional_payer_notes": "170.00% of Medicare Rates" } ] } ] }, { "description": "MALIGNANT BREAST DISORDERS - SOI : 4", "code_information": [ { "code": "3824", "type": "APR-DRG" } ], "standard_charges": [ { "setting": "inpatient", "minimum": 19067.31, "maximum": 20974.04, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Better Health - Medi Medi", "methodology": "case rate", "standard_charge_dollar": 20974.04, "additional_payer_notes": "110% of State Medicaid Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Better Health Medicaid", "methodology": "case rate", "standard_charge_dollar": 20974.04, "additional_payer_notes": "110% of State Medicaid Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "case rate", "standard_charge_dollar": 19067.31, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "UBH", "plan_name": "UBH Medicaid", "methodology": "case rate", "standard_charge_dollar": 19067.31, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicaid (02/01/2023 to 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 19448.66, "additional_payer_notes": "102% of State Medicaid Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicaid", "methodology": "case rate", "standard_charge_dollar": 19067.31, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup Medicaid", "methodology": "case rate", "standard_charge_dollar": 19067.31, "additional_payer_notes": "100% of State Medicaid Rates" } ] } ] }, { "description": "Hc Coronary Artery Byp W/Vein &Artery Graft 6 Vein", "code_information": [ { "code": "33523", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 1200.0, "minimum": 229.08, "maximum": 1200.0, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 885.93, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC All Payer (02-01-2023 to 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 1200.0 }, { "payer_name": "UHC", "plan_name": "UHC Oxford (02-01-2023 to 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 1200.0 }, { "payer_name": "UHC - Adhoc", "plan_name": "UHC - Adhoc All Payer", "methodology": "case rate", "standard_charge_dollar": 1200.0 }, { "payer_name": "UHC - Adhoc", "plan_name": "UHC - Adhoc Oxford", "methodology": "case rate", "standard_charge_dollar": 1200.0 }, { "payer_name": "Wellchoice", "plan_name": "WELLCHOICE HMO of NJ (Empire) Commercial (HMO / HMO POS, PPO)", "methodology": "case rate", "standard_charge_dollar": 1200.0 }, { "payer_name": "Wellchoice", "plan_name": "WELLCHOICE HMO of NJ (Empire) Commercial (Indemnity)", "methodology": "case rate", "standard_charge_dollar": 1200.0 } ] } ] }, { "description": "Hc Assay Of Phenothiazine - G0480 - 30100385", "code_information": [ { "code": "G0480", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 46.0, "discounted_cash": 114.0, "minimum": 8.3996, "maximum": 754.8, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 46.0, "additional_payer_notes": "212.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medical Rental Network", "methodology": "fee schedule", "standard_charge_dollar": 46.0, "additional_payer_notes": "212.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 46.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "ALLY-ALIGN (FKA SPARTAN PLAN NJ, INC.)", "plan_name": "ALLY-ALIGN (FKA SPARTAN PLAN NJ, INC.)", "methodology": "fee schedule", "standard_charge_dollar": 46.0, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Americhoice (UHC)", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 46.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Amerihealth", "plan_name": "Amerihealth Medicare", "methodology": "fee schedule", "standard_charge_dollar": 46.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 46.0, "additional_payer_notes": "Laboratory - 145.00% of Medicare Rates" }, { "payer_name": "Clover Health", "plan_name": "Clover Medicare", "methodology": "fee schedule", "standard_charge_dollar": 46.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Coventry", "plan_name": "Coventry Auto", "methodology": "fee schedule", "standard_charge_dollar": 46.0, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Coventry", "plan_name": "Coventry Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 46.0, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "fee schedule", "standard_charge_dollar": 46.0, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Fairprice Healthcare Holdings", "plan_name": "Fairprice Healthcare Holdings", "methodology": "fee schedule", "standard_charge_dollar": 46.0, "additional_payer_notes": "Laboratory - 120.00% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ HMO POS", "methodology": "fee schedule", "standard_charge_dollar": 32.48, "additional_payer_notes": "177.30% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ Indemnity", "methodology": "fee schedule", "standard_charge_dollar": 32.48, "additional_payer_notes": "177.30% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ PPO", "methodology": "fee schedule", "standard_charge_dollar": 32.48, "additional_payer_notes": "177.30% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon Medicare", "methodology": "fee schedule", "standard_charge_dollar": 46.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Military Tricare", "methodology": "fee schedule", "standard_charge_dollar": 46.0, "additional_payer_notes": "80.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 46.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 46.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC All Payer (02-01-2023 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 46.0 }, { "payer_name": "UHC", "plan_name": "UHC Medicaid (02/01/2023 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 46.0 }, { "payer_name": "UHC", "plan_name": "UHC Oxford (02-01-2023 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 46.0 }, { "payer_name": "UHC - Adhoc", "plan_name": "UHC - Adhoc All Payer", "methodology": "fee schedule", "standard_charge_dollar": 46.0 }, { "payer_name": "UHC - Adhoc", "plan_name": "UHC - Adhoc Oxford", "methodology": "fee schedule", "standard_charge_dollar": 46.0 }, { "payer_name": "Wellcare", "plan_name": "Wellcare Insurance Exchange", "methodology": "fee schedule", "standard_charge_dollar": 46.0, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 46.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup Medicare", "methodology": "fee schedule", "standard_charge_dollar": 46.0, "additional_payer_notes": "100.00% of Medicare Rates" } ] } ] }, { "description": "Hc Nm Myocardial Spect Single Study At Rest Or Stress", "code_information": [ { "code": "78451", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 5829.35, "discounted_cash": 1530.0, "minimum": 822.12, "maximum": 4954.9475, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 3244.72, "additional_payer_notes": "212.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medical Rental Network", "methodology": "fee schedule", "standard_charge_dollar": 3244.72, "additional_payer_notes": "212.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1530.53, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "ALLY-ALIGN (FKA SPARTAN PLAN NJ, INC.)", "plan_name": "ALLY-ALIGN (FKA SPARTAN PLAN NJ, INC.)", "methodology": "fee schedule", "standard_charge_dollar": 1607.06, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Americhoice (UHC)", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1530.53, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Amerihealth", "plan_name": "Amerihealth HMO", "methodology": "fee schedule", "standard_charge_dollar": 822.12 }, { "payer_name": "Amerihealth", "plan_name": "Amerihealth Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1530.53, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 2249.11, "additional_payer_notes": "146.95% of Medicare Rates" }, { "payer_name": "Clover Health", "plan_name": "Clover Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1530.53, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Coventry", "plan_name": "Coventry Auto", "methodology": "fee schedule", "standard_charge_dollar": 3061.06, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Coventry", "plan_name": "Coventry Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 3061.06, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "fee schedule", "standard_charge_dollar": 2142.74, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Fairprice Healthcare Holdings", "plan_name": "Fairprice Healthcare Holdings", "methodology": "fee schedule", "standard_charge_dollar": 2448.85, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ HMO POS", "methodology": "fee schedule", "standard_charge_dollar": 2713.63, "additional_payer_notes": "177.30% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ Indemnity", "methodology": "fee schedule", "standard_charge_dollar": 2713.63, "additional_payer_notes": "177.30% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ PPO", "methodology": "fee schedule", "standard_charge_dollar": 2713.63, "additional_payer_notes": "177.30% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1530.53, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Military Tricare", "methodology": "fee schedule", "standard_charge_dollar": 1224.42, "additional_payer_notes": "80.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1530.53, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 1530.53, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC All Payer (02-01-2023 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 1958.91 }, { "payer_name": "UHC", "plan_name": "UHC Oxford (02-01-2023 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 1958.91 }, { "payer_name": "UHC - Adhoc", "plan_name": "UHC - Adhoc All Payer", "methodology": "fee schedule", "standard_charge_dollar": 1305.94 }, { "payer_name": "UHC - Adhoc", "plan_name": "UHC - Adhoc Oxford", "methodology": "fee schedule", "standard_charge_dollar": 1305.94 }, { "payer_name": "Wellcare", "plan_name": "Wellcare Insurance Exchange", "methodology": "fee schedule", "standard_charge_dollar": 2066.22, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1530.53, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1530.53, "additional_payer_notes": "100.00% of Medicare Rates" } ] } ] }, { "description": "Hc Antidepressants Tricyclic & Cyclicals 6/More - G0480 - 30100422", "code_information": [ { "code": "G0480", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 82.0, "discounted_cash": 114.0, "minimum": 8.3996, "maximum": 754.8, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 82.0, "additional_payer_notes": "212.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medical Rental Network", "methodology": "fee schedule", "standard_charge_dollar": 82.0, "additional_payer_notes": "212.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 82.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "ALLY-ALIGN (FKA SPARTAN PLAN NJ, INC.)", "plan_name": "ALLY-ALIGN (FKA SPARTAN PLAN NJ, INC.)", "methodology": "fee schedule", "standard_charge_dollar": 82.0, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Americhoice (UHC)", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 82.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Amerihealth", "plan_name": "Amerihealth Medicare", "methodology": "fee schedule", "standard_charge_dollar": 82.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 82.0, "additional_payer_notes": "Laboratory - 145.00% of Medicare Rates" }, { "payer_name": "Clover Health", "plan_name": "Clover Medicare", "methodology": "fee schedule", "standard_charge_dollar": 82.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Coventry", "plan_name": "Coventry Auto", "methodology": "fee schedule", "standard_charge_dollar": 82.0, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Coventry", "plan_name": "Coventry Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 82.0, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "fee schedule", "standard_charge_dollar": 82.0, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Fairprice Healthcare Holdings", "plan_name": "Fairprice Healthcare Holdings", "methodology": "fee schedule", "standard_charge_dollar": 82.0, "additional_payer_notes": "Laboratory - 120.00% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ HMO POS", "methodology": "fee schedule", "standard_charge_dollar": 57.89, "additional_payer_notes": "177.30% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ Indemnity", "methodology": "fee schedule", "standard_charge_dollar": 57.89, "additional_payer_notes": "177.30% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ PPO", "methodology": "fee schedule", "standard_charge_dollar": 57.89, "additional_payer_notes": "177.30% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon Medicare", "methodology": "fee schedule", "standard_charge_dollar": 82.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Military Tricare", "methodology": "fee schedule", "standard_charge_dollar": 82.0, "additional_payer_notes": "80.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 82.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 82.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC All Payer (02-01-2023 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 68.66 }, { "payer_name": "UHC", "plan_name": "UHC Medicaid (02/01/2023 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 82.0 }, { "payer_name": "UHC", "plan_name": "UHC Oxford (02-01-2023 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 68.66 }, { "payer_name": "UHC - Adhoc", "plan_name": "UHC - Adhoc All Payer", "methodology": "fee schedule", "standard_charge_dollar": 82.0 }, { "payer_name": "UHC - Adhoc", "plan_name": "UHC - Adhoc Oxford", "methodology": "fee schedule", "standard_charge_dollar": 82.0 }, { "payer_name": "Wellcare", "plan_name": "Wellcare Insurance Exchange", "methodology": "fee schedule", "standard_charge_dollar": 82.0, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 82.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup Medicare", "methodology": "fee schedule", "standard_charge_dollar": 82.0, "additional_payer_notes": "100.00% of Medicare Rates" } ] } ] }, { "description": "PROCEDURE W DIAG OF REHAB, AFTERCARE OR OTH CONTACT W HEALTH SERVICE - SOI : 2", "code_information": [ { "code": "8502", "type": "APR-DRG" } ], "standard_charges": [ { "setting": "inpatient", "minimum": 27952.61, "maximum": 30747.87, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Better Health - Medi Medi", "methodology": "case rate", "standard_charge_dollar": 30747.87, "additional_payer_notes": "110% of State Medicaid Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Better Health Medicaid", "methodology": "case rate", "standard_charge_dollar": 30747.87, "additional_payer_notes": "110% of State Medicaid Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "case rate", "standard_charge_dollar": 27952.61, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "UBH", "plan_name": "UBH Medicaid", "methodology": "case rate", "standard_charge_dollar": 27952.61, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicaid (02/01/2023 to 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 28511.66, "additional_payer_notes": "102% of State Medicaid Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicaid", "methodology": "case rate", "standard_charge_dollar": 27952.61, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup Medicaid", "methodology": "case rate", "standard_charge_dollar": 27952.61, "additional_payer_notes": "100% of State Medicaid Rates" } ] } ] }, { "description": "NEONATE BWT <1500G W MAJOR PROCEDURE - SOI : 2", "code_information": [ { "code": "5882", "type": "APR-DRG" } ], "standard_charges": [ { "setting": "inpatient", "minimum": 208357.54, "maximum": 229193.29, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Better Health - Medi Medi", "methodology": "case rate", "standard_charge_dollar": 229193.29, "additional_payer_notes": "110% of State Medicaid Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Better Health Medicaid", "methodology": "case rate", "standard_charge_dollar": 229193.29, "additional_payer_notes": "110% of State Medicaid Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "case rate", "standard_charge_dollar": 208357.54, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "UBH", "plan_name": "UBH Medicaid", "methodology": "case rate", "standard_charge_dollar": 208357.54, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicaid (02/01/2023 to 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 212524.69, "additional_payer_notes": "102% of State Medicaid Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicaid", "methodology": "case rate", "standard_charge_dollar": 208357.54, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup Medicaid", "methodology": "case rate", "standard_charge_dollar": 208357.54, "additional_payer_notes": "100% of State Medicaid Rates" } ] } ] }, { "description": "Hc Ct Angio,Lower Extrem,Combo,Image Prc", "code_information": [ { "code": "73706", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 1100.0, "discounted_cash": 207.0, "minimum": 165.888, "maximum": 935.0, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 439.6, "additional_payer_notes": "212.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medical Rental Network", "methodology": "fee schedule", "standard_charge_dollar": 439.6, "additional_payer_notes": "212.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 207.36, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "ALLY-ALIGN (FKA SPARTAN PLAN NJ, INC.)", "plan_name": "ALLY-ALIGN (FKA SPARTAN PLAN NJ, INC.)", "methodology": "fee schedule", "standard_charge_dollar": 217.73, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Americhoice (UHC)", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 207.36, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Amerihealth", "plan_name": "Amerihealth HMO", "methodology": "fee schedule", "standard_charge_dollar": 565.81 }, { "payer_name": "Amerihealth", "plan_name": "Amerihealth Medicare", "methodology": "fee schedule", "standard_charge_dollar": 207.36, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 304.72, "additional_payer_notes": "146.95% of Medicare Rates" }, { "payer_name": "Clover Health", "plan_name": "Clover Medicare", "methodology": "fee schedule", "standard_charge_dollar": 207.36, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Coventry", "plan_name": "Coventry Auto", "methodology": "fee schedule", "standard_charge_dollar": 414.72, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Coventry", "plan_name": "Coventry Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 414.72, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "fee schedule", "standard_charge_dollar": 290.3, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Fairprice Healthcare Holdings", "plan_name": "Fairprice Healthcare Holdings", "methodology": "fee schedule", "standard_charge_dollar": 331.78, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ HMO POS", "methodology": "fee schedule", "standard_charge_dollar": 367.65, "additional_payer_notes": "177.30% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ Indemnity", "methodology": "fee schedule", "standard_charge_dollar": 367.65, "additional_payer_notes": "177.30% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ PPO", "methodology": "fee schedule", "standard_charge_dollar": 367.65, "additional_payer_notes": "177.30% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon Medicare", "methodology": "fee schedule", "standard_charge_dollar": 207.36, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Military Tricare", "methodology": "fee schedule", "standard_charge_dollar": 165.89, "additional_payer_notes": "80.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 207.36, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 207.36, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC All Payer (02-01-2023 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 267.83 }, { "payer_name": "UHC", "plan_name": "UHC Oxford (02-01-2023 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 267.83 }, { "payer_name": "UHC - Adhoc", "plan_name": "UHC - Adhoc All Payer", "methodology": "fee schedule", "standard_charge_dollar": 178.55 }, { "payer_name": "UHC - Adhoc", "plan_name": "UHC - Adhoc Oxford", "methodology": "fee schedule", "standard_charge_dollar": 178.55 }, { "payer_name": "Wellcare", "plan_name": "Wellcare Insurance Exchange", "methodology": "fee schedule", "standard_charge_dollar": 279.94, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 207.36, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup Medicare", "methodology": "fee schedule", "standard_charge_dollar": 207.36, "additional_payer_notes": "100.00% of Medicare Rates" } ] } ] }, { "description": "Hc Clsd Treat Prox/Shaft Fibula Fx Wo Manip", "code_information": [ { "code": "27780", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 839.01, "discounted_cash": 291.0, "minimum": 160.167, "maximum": 839.01, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 618.19, "additional_payer_notes": "212.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medical Rental Network", "methodology": "fee schedule", "standard_charge_dollar": 618.19, "additional_payer_notes": "212.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 291.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "ALLY-ALIGN (FKA SPARTAN PLAN NJ, INC.)", "plan_name": "ALLY-ALIGN (FKA SPARTAN PLAN NJ, INC.)", "methodology": "fee schedule", "standard_charge_dollar": 306.18, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Americhoice (UHC)", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 291.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Amerihealth", "plan_name": "Amerihealth Medicare", "methodology": "fee schedule", "standard_charge_dollar": 291.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 428.51, "additional_payer_notes": "146.95% of Medicare Rates" }, { "payer_name": "Clover Health", "plan_name": "Clover Medicare", "methodology": "fee schedule", "standard_charge_dollar": 291.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Coventry", "plan_name": "Coventry Auto", "methodology": "fee schedule", "standard_charge_dollar": 583.2, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Coventry", "plan_name": "Coventry Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 583.2, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "fee schedule", "standard_charge_dollar": 408.24, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Fairprice Healthcare Holdings", "plan_name": "Fairprice Healthcare Holdings", "methodology": "fee schedule", "standard_charge_dollar": 466.56, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ HMO POS", "methodology": "fee schedule", "standard_charge_dollar": 517.01, "additional_payer_notes": "177.30% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ Indemnity", "methodology": "fee schedule", "standard_charge_dollar": 517.01, "additional_payer_notes": "177.30% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ PPO", "methodology": "fee schedule", "standard_charge_dollar": 517.01, "additional_payer_notes": "177.30% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon Medicare", "methodology": "fee schedule", "standard_charge_dollar": 291.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Military Tricare", "methodology": "fee schedule", "standard_charge_dollar": 233.28, "additional_payer_notes": "80.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 291.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 291.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC All Payer (02-01-2023 to 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 839.01 }, { "payer_name": "UHC", "plan_name": "UHC Oxford (02-01-2023 to 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 839.01 }, { "payer_name": "UHC - Adhoc", "plan_name": "UHC - Adhoc All Payer", "methodology": "case rate", "standard_charge_dollar": 839.01 }, { "payer_name": "UHC - Adhoc", "plan_name": "UHC - Adhoc Oxford", "methodology": "case rate", "standard_charge_dollar": 839.01 }, { "payer_name": "Wellcare", "plan_name": "Wellcare Insurance Exchange", "methodology": "fee schedule", "standard_charge_dollar": 393.66, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 291.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup Medicare", "methodology": "fee schedule", "standard_charge_dollar": 291.6, "additional_payer_notes": "100.00% of Medicare Rates" } ] } ] }, { "description": "Hc External Ecg Rec>48Hr<7D Recording", "code_information": [ { "code": "93242", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 169.2, "discounted_cash": 44.0, "minimum": 32.3003, "maximum": 169.2, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 93.6, "additional_payer_notes": "212.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medical Rental Network", "methodology": "fee schedule", "standard_charge_dollar": 93.6, "additional_payer_notes": "212.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 44.15, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "ALLY-ALIGN (FKA SPARTAN PLAN NJ, INC.)", "plan_name": "ALLY-ALIGN (FKA SPARTAN PLAN NJ, INC.)", "methodology": "fee schedule", "standard_charge_dollar": 46.36, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Americhoice (UHC)", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 44.15, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Amerihealth", "plan_name": "Amerihealth Medicare", "methodology": "fee schedule", "standard_charge_dollar": 44.15, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 64.88, "additional_payer_notes": "146.95% of Medicare Rates" }, { "payer_name": "Clover Health", "plan_name": "Clover Medicare", "methodology": "fee schedule", "standard_charge_dollar": 44.15, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Coventry", "plan_name": "Coventry Auto", "methodology": "fee schedule", "standard_charge_dollar": 88.3, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Coventry", "plan_name": "Coventry Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 88.3, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "fee schedule", "standard_charge_dollar": 61.81, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Fairprice Healthcare Holdings", "plan_name": "Fairprice Healthcare Holdings", "methodology": "fee schedule", "standard_charge_dollar": 70.64, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ HMO POS", "methodology": "fee schedule", "standard_charge_dollar": 78.28, "additional_payer_notes": "177.30% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ Indemnity", "methodology": "fee schedule", "standard_charge_dollar": 78.28, "additional_payer_notes": "177.30% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ PPO", "methodology": "fee schedule", "standard_charge_dollar": 78.28, "additional_payer_notes": "177.30% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon Medicare", "methodology": "fee schedule", "standard_charge_dollar": 44.15, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Military Tricare", "methodology": "fee schedule", "standard_charge_dollar": 35.32, "additional_payer_notes": "80.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 44.15, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 44.15, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC All Payer (02-01-2023 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 169.2 }, { "payer_name": "UHC", "plan_name": "UHC Oxford (02-01-2023 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 169.2 }, { "payer_name": "UHC - Adhoc", "plan_name": "UHC - Adhoc All Payer", "methodology": "fee schedule", "standard_charge_dollar": 169.2 }, { "payer_name": "UHC - Adhoc", "plan_name": "UHC - Adhoc Oxford", "methodology": "fee schedule", "standard_charge_dollar": 169.2 }, { "payer_name": "Wellcare", "plan_name": "Wellcare Insurance Exchange", "methodology": "fee schedule", "standard_charge_dollar": 59.6, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 44.15, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup Medicare", "methodology": "fee schedule", "standard_charge_dollar": 44.15, "additional_payer_notes": "100.00% of Medicare Rates" } ] } ] }, { "description": "Hc Repair Of Vagina", "code_information": [ { "code": "57200", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 11806.4, "discounted_cash": 3826.0, "minimum": 1715.0, "maximum": 9445.12, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 8113.13, "additional_payer_notes": "212.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medical Rental Network", "methodology": "fee schedule", "standard_charge_dollar": 8113.13, "additional_payer_notes": "212.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3826.95, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "ALLY-ALIGN (FKA SPARTAN PLAN NJ, INC.)", "plan_name": "ALLY-ALIGN (FKA SPARTAN PLAN NJ, INC.)", "methodology": "fee schedule", "standard_charge_dollar": 4018.3, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Americhoice (UHC)", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3826.95, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Amerihealth", "plan_name": "Amerihealth Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3826.95, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 5623.7, "additional_payer_notes": "146.95% of Medicare Rates" }, { "payer_name": "Clover Health", "plan_name": "Clover Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3826.95, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Coventry", "plan_name": "Coventry Auto", "methodology": "fee schedule", "standard_charge_dollar": 7653.9, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Coventry", "plan_name": "Coventry Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 7653.9, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "fee schedule", "standard_charge_dollar": 5357.73, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Fairprice Healthcare Holdings", "plan_name": "Fairprice Healthcare Holdings", "methodology": "fee schedule", "standard_charge_dollar": 6123.12, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ HMO POS", "methodology": "fee schedule", "standard_charge_dollar": 6785.18, "additional_payer_notes": "177.30% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ Indemnity", "methodology": "fee schedule", "standard_charge_dollar": 6785.18, "additional_payer_notes": "177.30% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ PPO", "methodology": "fee schedule", "standard_charge_dollar": 6785.18, "additional_payer_notes": "177.30% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3826.95, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Military Tricare", "methodology": "fee schedule", "standard_charge_dollar": 3061.56, "additional_payer_notes": "80.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3826.95, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 3826.95, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC All Payer (02-01-2023 to 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 4415.0 }, { "payer_name": "UHC", "plan_name": "UHC Oxford (02-01-2023 to 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 4020.0 }, { "payer_name": "UHC - Adhoc", "plan_name": "UHC - Adhoc All Payer", "methodology": "case rate", "standard_charge_dollar": 4687.0 }, { "payer_name": "UHC - Adhoc", "plan_name": "UHC - Adhoc Oxford", "methodology": "case rate", "standard_charge_dollar": 4143.0 }, { "payer_name": "Wellcare", "plan_name": "Wellcare Insurance Exchange", "methodology": "fee schedule", "standard_charge_dollar": 5166.38, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3826.95, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellchoice", "plan_name": "WELLCHOICE HMO of NJ (Empire) Commercial (HMO / HMO POS, PPO)", "methodology": "case rate", "standard_charge_dollar": 1715.0 }, { "payer_name": "Wellchoice", "plan_name": "WELLCHOICE HMO of NJ (Empire) Commercial (Indemnity)", "methodology": "case rate", "standard_charge_dollar": 1978.0 }, { "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3826.95, "additional_payer_notes": "100.00% of Medicare Rates" } ] } ] }, { "description": "Hc Stool Culture,Salmonella & Shigella", "code_information": [ { "code": "87045", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 43.0, "discounted_cash": 9.0, "minimum": 5.66, "maximum": 36.55, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 20.01, "additional_payer_notes": "212.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medical Rental Network", "methodology": "fee schedule", "standard_charge_dollar": 20.01, "additional_payer_notes": "212.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 9.44, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "ALLY-ALIGN (FKA SPARTAN PLAN NJ, INC.)", "plan_name": "ALLY-ALIGN (FKA SPARTAN PLAN NJ, INC.)", "methodology": "fee schedule", "standard_charge_dollar": 9.91, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Americhoice (UHC)", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 9.44, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Amerihealth", "plan_name": "Amerihealth Medicare", "methodology": "fee schedule", "standard_charge_dollar": 9.44, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 13.69, "additional_payer_notes": "Laboratory - 145.00% of Medicare Rates" }, { "payer_name": "Clover Health", "plan_name": "Clover Medicare", "methodology": "fee schedule", "standard_charge_dollar": 9.44, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Coventry", "plan_name": "Coventry Auto", "methodology": "fee schedule", "standard_charge_dollar": 18.88, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Coventry", "plan_name": "Coventry Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 18.88, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "fee schedule", "standard_charge_dollar": 13.22, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Fairprice Healthcare Holdings", "plan_name": "Fairprice Healthcare Holdings", "methodology": "fee schedule", "standard_charge_dollar": 11.33, "additional_payer_notes": "Laboratory - 120.00% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ HMO POS", "methodology": "fee schedule", "standard_charge_dollar": 30.36, "additional_payer_notes": "177.30% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ Indemnity", "methodology": "fee schedule", "standard_charge_dollar": 30.36, "additional_payer_notes": "177.30% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ PPO", "methodology": "fee schedule", "standard_charge_dollar": 30.36, "additional_payer_notes": "177.30% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon Medicare", "methodology": "fee schedule", "standard_charge_dollar": 9.44, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Military Tricare", "methodology": "fee schedule", "standard_charge_dollar": 7.55, "additional_payer_notes": "80.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 9.44, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 9.44, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC All Payer (02-01-2023 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 5.66 }, { "payer_name": "UHC", "plan_name": "UHC Medicaid (02/01/2023 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 7.55 }, { "payer_name": "UHC", "plan_name": "UHC Oxford (02-01-2023 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 5.66 }, { "payer_name": "UHC - Adhoc", "plan_name": "UHC - Adhoc All Payer", "methodology": "fee schedule", "standard_charge_dollar": 9.44 }, { "payer_name": "UHC - Adhoc", "plan_name": "UHC - Adhoc Oxford", "methodology": "fee schedule", "standard_charge_dollar": 9.44 }, { "payer_name": "Wellcare", "plan_name": "Wellcare Insurance Exchange", "methodology": "fee schedule", "standard_charge_dollar": 12.74, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 9.44, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup Medicare", "methodology": "fee schedule", "standard_charge_dollar": 9.44, "additional_payer_notes": "100.00% of Medicare Rates" } ] } ] }, { "description": "PATHOLOGICAL FRACTURES AND MUSCULOSKELETAL AND CONNECTIVE TISSUE MALIGNANCY WITH MCC", "code_information": [ { "code": "542", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 21971.0, "minimum": 11397.78, "maximum": 39767.9082, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "case rate", "standard_charge_dollar": 39767.91, "additional_payer_notes": "181.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medical Rental Network", "methodology": "case rate", "standard_charge_dollar": 39767.91, "additional_payer_notes": "181.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "case rate", "standard_charge_dollar": 17949.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "ALLY-ALIGN (FKA SPARTAN PLAN NJ, INC.)", "plan_name": "ALLY-ALIGN (FKA SPARTAN PLAN NJ, INC.)", "methodology": "case rate", "standard_charge_dollar": 23069.78, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Americhoice (UHC)", "plan_name": "UHC Medicare", "methodology": "case rate", "standard_charge_dollar": 17949.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Amerihealth", "plan_name": "Amerihealth Medicare", "methodology": "case rate", "standard_charge_dollar": 17949.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Commercial", "methodology": "case rate", "standard_charge_dollar": 25843.9 }, { "payer_name": "Clover Health", "plan_name": "Clover Medicare", "methodology": "case rate", "standard_charge_dollar": 17949.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Coventry", "plan_name": "Coventry Auto", "methodology": "case rate", "standard_charge_dollar": 37351.07, "additional_payer_notes": "170.00% of Medicare Rates" }, { "payer_name": "Coventry", "plan_name": "Coventry Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 37351.07, "additional_payer_notes": "170.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "case rate", "standard_charge_dollar": 28562.59, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Fairprice Healthcare Holdings", "plan_name": "Fairprice Healthcare Holdings", "methodology": "case rate", "standard_charge_dollar": 35153.95, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon Medicare", "methodology": "case rate", "standard_charge_dollar": 17949.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon NJ Health Medicaid", "methodology": "case rate", "standard_charge_dollar": 11397.78 }, { "payer_name": "Humana", "plan_name": "Humana Military Tricare", "methodology": "case rate", "standard_charge_dollar": 17576.98, "additional_payer_notes": "80.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 21971.22, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 36769.4 }, { "payer_name": "UBH", "plan_name": "UBH Medicare", "methodology": "case rate", "standard_charge_dollar": 17949.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC All Payer (02-01-2023 to 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 29776.12 }, { "payer_name": "UHC", "plan_name": "UHC Oxford (02-01-2023 to 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 25949.89 }, { "payer_name": "UHC - Adhoc", "plan_name": "UHC - Adhoc All Payer", "methodology": "case rate", "standard_charge_dollar": 31607.98 }, { "payer_name": "UHC - Adhoc", "plan_name": "UHC - Adhoc Oxford", "methodology": "case rate", "standard_charge_dollar": 26741.28 }, { "payer_name": "Wellcare", "plan_name": "Wellcare Insurance Exchange", "methodology": "case rate", "standard_charge_dollar": 29661.15, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "case rate", "standard_charge_dollar": 17949.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup Medicare", "methodology": "case rate", "standard_charge_dollar": 17949.0, "additional_payer_notes": "100.00% of Medicare Rates" } ] } ] }, { "description": "Hc Office/Outpatient New Moderate Mdm 45-59 Minutes - G0463 - 76100004", "code_information": [ { "code": "G0463", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 1081.0, "discounted_cash": 157.0, "minimum": 19.09, "maximum": 1131.35, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 333.67, "additional_payer_notes": "212.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medical Rental Network", "methodology": "fee schedule", "standard_charge_dollar": 333.67, "additional_payer_notes": "212.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 157.39, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "ALLY-ALIGN (FKA SPARTAN PLAN NJ, INC.)", "plan_name": "ALLY-ALIGN (FKA SPARTAN PLAN NJ, INC.)", "methodology": "fee schedule", "standard_charge_dollar": 165.26, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Americhoice (UHC)", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 157.39, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Amerihealth", "plan_name": "Amerihealth Medicare", "methodology": "fee schedule", "standard_charge_dollar": 157.39, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 231.28, "additional_payer_notes": "146.95% of Medicare Rates" }, { "payer_name": "Clover Health", "plan_name": "Clover Medicare", "methodology": "fee schedule", "standard_charge_dollar": 157.39, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Coventry", "plan_name": "Coventry Auto", "methodology": "fee schedule", "standard_charge_dollar": 314.78, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Coventry", "plan_name": "Coventry Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 314.78, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "fee schedule", "standard_charge_dollar": 220.35, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Fairprice Healthcare Holdings", "plan_name": "Fairprice Healthcare Holdings", "methodology": "fee schedule", "standard_charge_dollar": 251.82, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ HMO POS", "methodology": "fee schedule", "standard_charge_dollar": 279.05, "additional_payer_notes": "177.30% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ Indemnity", "methodology": "fee schedule", "standard_charge_dollar": 279.05, "additional_payer_notes": "177.30% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ PPO", "methodology": "fee schedule", "standard_charge_dollar": 279.05, "additional_payer_notes": "177.30% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon Medicare", "methodology": "fee schedule", "standard_charge_dollar": 157.39, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Military Tricare", "methodology": "fee schedule", "standard_charge_dollar": 125.91, "additional_payer_notes": "80.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 157.39, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 157.39, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Insurance Exchange", "methodology": "fee schedule", "standard_charge_dollar": 212.48, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 157.39, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup Medicare", "methodology": "fee schedule", "standard_charge_dollar": 157.39, "additional_payer_notes": "100.00% of Medicare Rates" } ] } ] }, { "description": "Hc Brucella, Antibody", "code_information": [ { "code": "86622", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 24.0, "discounted_cash": 8.0, "minimum": 4.5816, "maximum": 20.4, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 18.93, "additional_payer_notes": "212.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medical Rental Network", "methodology": "fee schedule", "standard_charge_dollar": 18.93, "additional_payer_notes": "212.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 8.93, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "ALLY-ALIGN (FKA SPARTAN PLAN NJ, INC.)", "plan_name": "ALLY-ALIGN (FKA SPARTAN PLAN NJ, INC.)", "methodology": "fee schedule", "standard_charge_dollar": 9.38, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Americhoice (UHC)", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 8.93, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Amerihealth", "plan_name": "Amerihealth Medicare", "methodology": "fee schedule", "standard_charge_dollar": 8.93, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 12.95, "additional_payer_notes": "Laboratory - 145.00% of Medicare Rates" }, { "payer_name": "Clover Health", "plan_name": "Clover Medicare", "methodology": "fee schedule", "standard_charge_dollar": 8.93, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Coventry", "plan_name": "Coventry Auto", "methodology": "fee schedule", "standard_charge_dollar": 17.86, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Coventry", "plan_name": "Coventry Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 17.86, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "fee schedule", "standard_charge_dollar": 12.5, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Fairprice Healthcare Holdings", "plan_name": "Fairprice Healthcare Holdings", "methodology": "fee schedule", "standard_charge_dollar": 10.72, "additional_payer_notes": "Laboratory - 120.00% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ HMO POS", "methodology": "fee schedule", "standard_charge_dollar": 16.94, "additional_payer_notes": "177.30% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ Indemnity", "methodology": "fee schedule", "standard_charge_dollar": 16.94, "additional_payer_notes": "177.30% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ PPO", "methodology": "fee schedule", "standard_charge_dollar": 16.94, "additional_payer_notes": "177.30% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon Medicare", "methodology": "fee schedule", "standard_charge_dollar": 8.93, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Military Tricare", "methodology": "fee schedule", "standard_charge_dollar": 7.14, "additional_payer_notes": "80.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 8.93, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 8.93, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC All Payer (02-01-2023 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 5.36 }, { "payer_name": "UHC", "plan_name": "UHC Medicaid (02/01/2023 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 7.14 }, { "payer_name": "UHC", "plan_name": "UHC Oxford (02-01-2023 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 5.36 }, { "payer_name": "UHC - Adhoc", "plan_name": "UHC - Adhoc All Payer", "methodology": "fee schedule", "standard_charge_dollar": 8.93 }, { "payer_name": "UHC - Adhoc", "plan_name": "UHC - Adhoc Oxford", "methodology": "fee schedule", "standard_charge_dollar": 8.93 }, { "payer_name": "Wellcare", "plan_name": "Wellcare Insurance Exchange", "methodology": "fee schedule", "standard_charge_dollar": 12.06, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 8.93, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup Medicare", "methodology": "fee schedule", "standard_charge_dollar": 8.93, "additional_payer_notes": "100.00% of Medicare Rates" } ] } ] }, { "description": "Repair nerve add-on", "code_information": [ { "code": "64832", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 1856.84, "minimum": 354.4708, "maximum": 1856.84, "payers_information": [ { "payer_name": "Horizon", "plan_name": "Horizon NJ Health Medicaid", "methodology": "percent of total billed charges", "standard_charge_percentage": 19.58, "median_amount": 565.0, "10th_percentile": 565.0, "90th_percentile": 565.0, "count": "1 through 10" }, { "payer_name": "UHC", "plan_name": "UHC All Payer (02-01-2023 to 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 1856.84 }, { "payer_name": "UHC", "plan_name": "UHC Oxford (02-01-2023 to 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 1856.84 }, { "payer_name": "UHC - Adhoc", "plan_name": "UHC - Adhoc All Payer", "methodology": "case rate", "standard_charge_dollar": 1856.84 }, { "payer_name": "UHC - Adhoc", "plan_name": "UHC - Adhoc Oxford", "methodology": "case rate", "standard_charge_dollar": 1856.84 }, { "payer_name": "Wellchoice", "plan_name": "WELLCHOICE HMO of NJ (Empire) Commercial (HMO / HMO POS, PPO)", "methodology": "case rate", "standard_charge_dollar": 1715.0 }, { "payer_name": "Wellchoice", "plan_name": "WELLCHOICE HMO of NJ (Empire) Commercial (Indemnity)", "methodology": "case rate", "standard_charge_dollar": 1856.84 }, { "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup Medicaid", "methodology": "percent of total billed charges", "standard_charge_percentage": 19.09, "median_amount": 269.03, "10th_percentile": 269.03, "90th_percentile": 269.03, "count": "1 through 10" } ] } ] }, { "description": "Hc Ro Radiation Therapy,Dosimetry Plan", "code_information": [ { "code": "77300", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 635.91, "discounted_cash": 158.0, "minimum": 121.3952, "maximum": 635.91, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 336.87, "additional_payer_notes": "212.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medical Rental Network", "methodology": "fee schedule", "standard_charge_dollar": 336.87, "additional_payer_notes": "212.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 158.9, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "ALLY-ALIGN (FKA SPARTAN PLAN NJ, INC.)", "plan_name": "ALLY-ALIGN (FKA SPARTAN PLAN NJ, INC.)", "methodology": "fee schedule", "standard_charge_dollar": 166.85, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Americhoice (UHC)", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 158.9, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Amerihealth", "plan_name": "Amerihealth Medicare", "methodology": "fee schedule", "standard_charge_dollar": 158.9, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 233.5, "additional_payer_notes": "146.95% of Medicare Rates" }, { "payer_name": "Clover Health", "plan_name": "Clover Medicare", "methodology": "fee schedule", "standard_charge_dollar": 158.9, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Coventry", "plan_name": "Coventry Auto", "methodology": "fee schedule", "standard_charge_dollar": 317.8, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Coventry", "plan_name": "Coventry Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 317.8, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "fee schedule", "standard_charge_dollar": 222.46, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Fairprice Healthcare Holdings", "plan_name": "Fairprice Healthcare Holdings", "methodology": "fee schedule", "standard_charge_dollar": 254.24, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ HMO POS", "methodology": "fee schedule", "standard_charge_dollar": 281.73, "additional_payer_notes": "177.30% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ Indemnity", "methodology": "fee schedule", "standard_charge_dollar": 281.73, "additional_payer_notes": "177.30% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ PPO", "methodology": "fee schedule", "standard_charge_dollar": 281.73, "additional_payer_notes": "177.30% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon Medicare", "methodology": "fee schedule", "standard_charge_dollar": 158.9, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon NJ Health Medicaid", "methodology": "percent of total billed charges", "standard_charge_percentage": 19.58, "median_amount": 249.02, "10th_percentile": 249.02, "90th_percentile": 249.02, "count": "1 through 10" }, { "payer_name": "Humana", "plan_name": "Humana Military Tricare", "methodology": "fee schedule", "standard_charge_dollar": 127.12, "additional_payer_notes": "80.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 158.9, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 158.9, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC - Adhoc", "plan_name": "UHC - Adhoc Oxford", "methodology": "fee schedule", "standard_charge_dollar": 635.91 }, { "payer_name": "Wellcare", "plan_name": "Wellcare Insurance Exchange", "methodology": "fee schedule", "standard_charge_dollar": 214.52, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 158.9, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellchoice", "plan_name": "WELLCHOICE HMO of NJ (Empire) Commercial (HMO / HMO POS, PPO)", "methodology": "case rate", "standard_charge_dollar": 167.0 }, { "payer_name": "Wellchoice", "plan_name": "WELLCHOICE HMO of NJ (Empire) Commercial (Indemnity)", "methodology": "case rate", "standard_charge_dollar": 202.0 }, { "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup Medicare", "methodology": "fee schedule", "standard_charge_dollar": 158.9, "additional_payer_notes": "100.00% of Medicare Rates" } ] } ] }, { "description": "PERMANENT CARDIAC PACEMAKER IMPLANT WITH CC", "code_information": [ { "code": "243", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 26182.0, "minimum": 15949.9, "maximum": 49586.6259, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "case rate", "standard_charge_dollar": 47390.14, "additional_payer_notes": "181.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medical Rental Network", "methodology": "case rate", "standard_charge_dollar": 47390.14, "additional_payer_notes": "181.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "case rate", "standard_charge_dollar": 21330.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "ALLY-ALIGN (FKA SPARTAN PLAN NJ, INC.)", "plan_name": "ALLY-ALIGN (FKA SPARTAN PLAN NJ, INC.)", "methodology": "case rate", "standard_charge_dollar": 27491.52, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Americhoice (UHC)", "plan_name": "UHC Medicare", "methodology": "case rate", "standard_charge_dollar": 21330.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Amerihealth", "plan_name": "Amerihealth Medicare", "methodology": "case rate", "standard_charge_dollar": 21330.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Commercial", "methodology": "case rate", "standard_charge_dollar": 31175.07 }, { "payer_name": "Clover Health", "plan_name": "Clover Medicare", "methodology": "case rate", "standard_charge_dollar": 21330.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Coventry", "plan_name": "Coventry Auto", "methodology": "case rate", "standard_charge_dollar": 44510.08, "additional_payer_notes": "170.00% of Medicare Rates" }, { "payer_name": "Coventry", "plan_name": "Coventry Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 44510.08, "additional_payer_notes": "170.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "case rate", "standard_charge_dollar": 34037.12, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Fairprice Healthcare Holdings", "plan_name": "Fairprice Healthcare Holdings", "methodology": "case rate", "standard_charge_dollar": 41891.84, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon Medicare", "methodology": "case rate", "standard_charge_dollar": 21330.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon NJ Health Medicaid", "methodology": "case rate", "standard_charge_dollar": 15949.9 }, { "payer_name": "Humana", "plan_name": "Humana Military Tricare", "methodology": "case rate", "standard_charge_dollar": 20945.92, "additional_payer_notes": "80.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 26182.4, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 29843.6 }, { "payer_name": "UBH", "plan_name": "UBH Medicare", "methodology": "case rate", "standard_charge_dollar": 21330.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC All Payer (02-01-2023 to 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 35918.45 }, { "payer_name": "UHC", "plan_name": "UHC Oxford (02-01-2023 to 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 31302.92 }, { "payer_name": "UHC - Adhoc", "plan_name": "UHC - Adhoc All Payer", "methodology": "case rate", "standard_charge_dollar": 38128.19 }, { "payer_name": "UHC - Adhoc", "plan_name": "UHC - Adhoc Oxford", "methodology": "case rate", "standard_charge_dollar": 32257.56 }, { "payer_name": "Wellcare", "plan_name": "Wellcare Insurance Exchange", "methodology": "case rate", "standard_charge_dollar": 35346.24, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "case rate", "standard_charge_dollar": 21330.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup Medicare", "methodology": "case rate", "standard_charge_dollar": 21330.5, "additional_payer_notes": "100.00% of Medicare Rates" } ] } ] }, { "description": "Hc Glucose Tolerance Test (Gtt)", "code_information": [ { "code": "82951", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 122.0, "discounted_cash": 12.0, "minimum": 7.72, "maximum": 103.7, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 27.28, "additional_payer_notes": "212.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medical Rental Network", "methodology": "fee schedule", "standard_charge_dollar": 27.28, "additional_payer_notes": "212.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 12.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "ALLY-ALIGN (FKA SPARTAN PLAN NJ, INC.)", "plan_name": "ALLY-ALIGN (FKA SPARTAN PLAN NJ, INC.)", "methodology": "fee schedule", "standard_charge_dollar": 13.51, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Americhoice (UHC)", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 12.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Amerihealth", "plan_name": "Amerihealth Medicare", "methodology": "fee schedule", "standard_charge_dollar": 12.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 18.66, "additional_payer_notes": "A Indicator - 155.00% of Medicare Rates" }, { "payer_name": "Clover Health", "plan_name": "Clover Medicare", "methodology": "fee schedule", "standard_charge_dollar": 12.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Coventry", "plan_name": "Coventry Auto", "methodology": "fee schedule", "standard_charge_dollar": 25.74, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Coventry", "plan_name": "Coventry Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 25.74, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "fee schedule", "standard_charge_dollar": 18.02, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Fairprice Healthcare Holdings", "plan_name": "Fairprice Healthcare Holdings", "methodology": "fee schedule", "standard_charge_dollar": 15.44, "additional_payer_notes": "Laboratory - 120.00% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ HMO POS", "methodology": "fee schedule", "standard_charge_dollar": 86.13, "additional_payer_notes": "177.30% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ Indemnity", "methodology": "fee schedule", "standard_charge_dollar": 86.13, "additional_payer_notes": "177.30% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ PPO", "methodology": "fee schedule", "standard_charge_dollar": 86.13, "additional_payer_notes": "177.30% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon Medicare", "methodology": "fee schedule", "standard_charge_dollar": 12.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Military Tricare", "methodology": "fee schedule", "standard_charge_dollar": 10.3, "additional_payer_notes": "80.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 12.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 12.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC All Payer (02-01-2023 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 7.72 }, { "payer_name": "UHC", "plan_name": "UHC Medicaid (02/01/2023 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 10.3 }, { "payer_name": "UHC", "plan_name": "UHC Oxford (02-01-2023 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 7.72 }, { "payer_name": "UHC - Adhoc", "plan_name": "UHC - Adhoc All Payer", "methodology": "fee schedule", "standard_charge_dollar": 12.87 }, { "payer_name": "UHC - Adhoc", "plan_name": "UHC - Adhoc Oxford", "methodology": "fee schedule", "standard_charge_dollar": 12.87 }, { "payer_name": "Wellcare", "plan_name": "Wellcare Insurance Exchange", "methodology": "fee schedule", "standard_charge_dollar": 17.37, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 12.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup Medicare", "methodology": "fee schedule", "standard_charge_dollar": 12.87, "additional_payer_notes": "100.00% of Medicare Rates" } ] } ] }, { "description": "Hc Thoracoscopy W/Thera Wedge Resexn Addl Ipsilatrl", "code_information": [ { "code": "32667", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 400.0, "minimum": 76.36, "maximum": 400.0, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 136.38, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC All Payer (02-01-2023 to 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 400.0 }, { "payer_name": "UHC", "plan_name": "UHC Oxford (02-01-2023 to 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 400.0 }, { "payer_name": "UHC - Adhoc", "plan_name": "UHC - Adhoc All Payer", "methodology": "case rate", "standard_charge_dollar": 400.0 }, { "payer_name": "UHC - Adhoc", "plan_name": "UHC - Adhoc Oxford", "methodology": "case rate", "standard_charge_dollar": 400.0 }, { "payer_name": "Wellchoice", "plan_name": "WELLCHOICE HMO of NJ (Empire) Commercial (HMO / HMO POS, PPO)", "methodology": "case rate", "standard_charge_dollar": 400.0 }, { "payer_name": "Wellchoice", "plan_name": "WELLCHOICE HMO of NJ (Empire) Commercial (Indemnity)", "methodology": "case rate", "standard_charge_dollar": 400.0 } ] } ] }, { "description": "Hc Assay Of Prealbumin", "code_information": [ { "code": "84134", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 51.79, "discounted_cash": 14.0, "minimum": 8.75, "maximum": 44.0215, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 30.93, "additional_payer_notes": "212.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medical Rental Network", "methodology": "fee schedule", "standard_charge_dollar": 30.93, "additional_payer_notes": "212.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 14.59, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "ALLY-ALIGN (FKA SPARTAN PLAN NJ, INC.)", "plan_name": "ALLY-ALIGN (FKA SPARTAN PLAN NJ, INC.)", "methodology": "fee schedule", "standard_charge_dollar": 15.32, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Americhoice (UHC)", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 14.59, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Amerihealth", "plan_name": "Amerihealth Medicare", "methodology": "fee schedule", "standard_charge_dollar": 14.59, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 21.16, "additional_payer_notes": "Laboratory - 145.00% of Medicare Rates" }, { "payer_name": "Clover Health", "plan_name": "Clover Medicare", "methodology": "fee schedule", "standard_charge_dollar": 14.59, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Coventry", "plan_name": "Coventry Auto", "methodology": "fee schedule", "standard_charge_dollar": 29.18, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Coventry", "plan_name": "Coventry Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 29.18, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "fee schedule", "standard_charge_dollar": 20.43, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Fairprice Healthcare Holdings", "plan_name": "Fairprice Healthcare Holdings", "methodology": "fee schedule", "standard_charge_dollar": 17.51, "additional_payer_notes": "Laboratory - 120.00% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ HMO POS", "methodology": "fee schedule", "standard_charge_dollar": 36.56, "additional_payer_notes": "177.30% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ Indemnity", "methodology": "fee schedule", "standard_charge_dollar": 36.56, "additional_payer_notes": "177.30% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ PPO", "methodology": "fee schedule", "standard_charge_dollar": 36.56, "additional_payer_notes": "177.30% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon Medicare", "methodology": "fee schedule", "standard_charge_dollar": 14.59, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Military Tricare", "methodology": "fee schedule", "standard_charge_dollar": 11.67, "additional_payer_notes": "80.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 14.59, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 14.59, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC All Payer (02-01-2023 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 8.75 }, { "payer_name": "UHC", "plan_name": "UHC Medicaid (02/01/2023 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 11.67 }, { "payer_name": "UHC", "plan_name": "UHC Oxford (02-01-2023 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 8.75 }, { "payer_name": "UHC - Adhoc", "plan_name": "UHC - Adhoc All Payer", "methodology": "fee schedule", "standard_charge_dollar": 14.59 }, { "payer_name": "UHC - Adhoc", "plan_name": "UHC - Adhoc Oxford", "methodology": "fee schedule", "standard_charge_dollar": 14.59 }, { "payer_name": "Wellcare", "plan_name": "Wellcare Insurance Exchange", "methodology": "fee schedule", "standard_charge_dollar": 19.7, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 14.59, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup Medicare", "methodology": "fee schedule", "standard_charge_dollar": 14.59, "additional_payer_notes": "100.00% of Medicare Rates" } ] } ] }, { "description": "Exc Back Tum Deep 5 Cm/>", "code_information": [ { "code": "21933", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 16573.8, "discounted_cash": 3433.0, "minimum": 1715.0, "maximum": 13259.04, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 7280.0, "additional_payer_notes": "212.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medical Rental Network", "methodology": "fee schedule", "standard_charge_dollar": 7280.0, "additional_payer_notes": "212.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3433.96, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "ALLY-ALIGN (FKA SPARTAN PLAN NJ, INC.)", "plan_name": "ALLY-ALIGN (FKA SPARTAN PLAN NJ, INC.)", "methodology": "fee schedule", "standard_charge_dollar": 3605.66, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Americhoice (UHC)", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3433.96, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Amerihealth", "plan_name": "Amerihealth Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3433.96, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 5046.2, "additional_payer_notes": "146.95% of Medicare Rates" }, { "payer_name": "Clover Health", "plan_name": "Clover Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3433.96, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Coventry", "plan_name": "Coventry Auto", "methodology": "fee schedule", "standard_charge_dollar": 6867.92, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Coventry", "plan_name": "Coventry Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 6867.92, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "fee schedule", "standard_charge_dollar": 4807.54, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Fairprice Healthcare Holdings", "plan_name": "Fairprice Healthcare Holdings", "methodology": "fee schedule", "standard_charge_dollar": 5494.34, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ HMO POS", "methodology": "fee schedule", "standard_charge_dollar": 6088.41, "additional_payer_notes": "177.30% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ Indemnity", "methodology": "fee schedule", "standard_charge_dollar": 6088.41, "additional_payer_notes": "177.30% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ PPO", "methodology": "fee schedule", "standard_charge_dollar": 6088.41, "additional_payer_notes": "177.30% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3433.96, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon NJ Health Medicaid", "methodology": "percent of total billed charges", "standard_charge_percentage": 19.58, "median_amount": 1255.57, "10th_percentile": 1255.57, "90th_percentile": 1255.57, "count": "1 through 10" }, { "payer_name": "Humana", "plan_name": "Humana Military Tricare", "methodology": "fee schedule", "standard_charge_dollar": 2747.17, "additional_payer_notes": "80.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3433.96, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 3433.96, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC All Payer (02-01-2023 to 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 4415.0 }, { "payer_name": "UHC", "plan_name": "UHC Oxford (02-01-2023 to 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 4020.0 }, { "payer_name": "UHC - Adhoc", "plan_name": "UHC - Adhoc All Payer", "methodology": "case rate", "standard_charge_dollar": 4687.0 }, { "payer_name": "UHC - Adhoc", "plan_name": "UHC - Adhoc Oxford", "methodology": "case rate", "standard_charge_dollar": 4143.0 }, { "payer_name": "Wellcare", "plan_name": "Wellcare Insurance Exchange", "methodology": "fee schedule", "standard_charge_dollar": 4635.85, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3433.96, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellchoice", "plan_name": "WELLCHOICE HMO of NJ (Empire) Commercial (HMO / HMO POS, PPO)", "methodology": "case rate", "standard_charge_dollar": 1715.0 }, { "payer_name": "Wellchoice", "plan_name": "WELLCHOICE HMO of NJ (Empire) Commercial (Indemnity)", "methodology": "case rate", "standard_charge_dollar": 1978.0 }, { "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup Medicaid", "methodology": "percent of total billed charges", "standard_charge_percentage": 19.09, "median_amount": 1195.93, "10th_percentile": 1195.93, "90th_percentile": 2870.24, "count": "1 through 10" }, { "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3433.96, "additional_payer_notes": "100.00% of Medicare Rates" } ] } ] }, { "description": "Hc X-Ray Tomogram", "code_information": [ { "code": "76100", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 799.22, "discounted_cash": 123.0, "minimum": 98.872, "maximum": 679.337, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 262.01, "additional_payer_notes": "212.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medical Rental Network", "methodology": "fee schedule", "standard_charge_dollar": 262.01, "additional_payer_notes": "212.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 123.59, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "ALLY-ALIGN (FKA SPARTAN PLAN NJ, INC.)", "plan_name": "ALLY-ALIGN (FKA SPARTAN PLAN NJ, INC.)", "methodology": "fee schedule", "standard_charge_dollar": 129.77, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Americhoice (UHC)", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 123.59, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Amerihealth", "plan_name": "Amerihealth HMO", "methodology": "fee schedule", "standard_charge_dollar": 124.12 }, { "payer_name": "Amerihealth", "plan_name": "Amerihealth Medicare", "methodology": "fee schedule", "standard_charge_dollar": 123.59, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 181.62, "additional_payer_notes": "146.95% of Medicare Rates" }, { "payer_name": "Clover Health", "plan_name": "Clover Medicare", "methodology": "fee schedule", "standard_charge_dollar": 123.59, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Coventry", "plan_name": "Coventry Auto", "methodology": "fee schedule", "standard_charge_dollar": 247.18, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Coventry", "plan_name": "Coventry Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 247.18, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "fee schedule", "standard_charge_dollar": 173.03, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Fairprice Healthcare Holdings", "plan_name": "Fairprice Healthcare Holdings", "methodology": "fee schedule", "standard_charge_dollar": 197.74, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ HMO POS", "methodology": "fee schedule", "standard_charge_dollar": 219.13, "additional_payer_notes": "177.30% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ Indemnity", "methodology": "fee schedule", "standard_charge_dollar": 219.13, "additional_payer_notes": "177.30% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ PPO", "methodology": "fee schedule", "standard_charge_dollar": 219.13, "additional_payer_notes": "177.30% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon Medicare", "methodology": "fee schedule", "standard_charge_dollar": 123.59, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Military Tricare", "methodology": "fee schedule", "standard_charge_dollar": 98.87, "additional_payer_notes": "80.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 123.59, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 123.59, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC All Payer (02-01-2023 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 163.46 }, { "payer_name": "UHC", "plan_name": "UHC Oxford (02-01-2023 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 163.46 }, { "payer_name": "UHC - Adhoc", "plan_name": "UHC - Adhoc All Payer", "methodology": "fee schedule", "standard_charge_dollar": 108.97 }, { "payer_name": "UHC - Adhoc", "plan_name": "UHC - Adhoc Oxford", "methodology": "fee schedule", "standard_charge_dollar": 108.97 }, { "payer_name": "Wellcare", "plan_name": "Wellcare Insurance Exchange", "methodology": "fee schedule", "standard_charge_dollar": 166.85, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 123.59, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup Medicare", "methodology": "fee schedule", "standard_charge_dollar": 123.59, "additional_payer_notes": "100.00% of Medicare Rates" } ] } ] }, { "description": "Hc Massage Therapy Ea 15 Min", "code_information": [ { "code": "97124", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 176.0, "discounted_cash": 33.0, "minimum": 26.656, "maximum": 176.0, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 70.64, "additional_payer_notes": "212.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medical Rental Network", "methodology": "fee schedule", "standard_charge_dollar": 70.64, "additional_payer_notes": "212.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 33.32, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "ALLY-ALIGN (FKA SPARTAN PLAN NJ, INC.)", "plan_name": "ALLY-ALIGN (FKA SPARTAN PLAN NJ, INC.)", "methodology": "fee schedule", "standard_charge_dollar": 34.99, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Americhoice (UHC)", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 33.32, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Amerihealth", "plan_name": "Amerihealth Medicare", "methodology": "fee schedule", "standard_charge_dollar": 33.32, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 158.0, "additional_payer_notes": "A Indicator - 155.00% of Medicare Rates" }, { "payer_name": "Clover Health", "plan_name": "Clover Medicare", "methodology": "fee schedule", "standard_charge_dollar": 33.32, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Coventry", "plan_name": "Coventry Auto", "methodology": "fee schedule", "standard_charge_dollar": 66.64, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Coventry", "plan_name": "Coventry Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 66.64, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "fee schedule", "standard_charge_dollar": 46.65, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Fairprice Healthcare Holdings", "plan_name": "Fairprice Healthcare Holdings", "methodology": "fee schedule", "standard_charge_dollar": 53.31 }, { "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ HMO POS", "methodology": "fee schedule", "standard_charge_dollar": 124.26, "additional_payer_notes": "177.30% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ Indemnity", "methodology": "fee schedule", "standard_charge_dollar": 124.26, "additional_payer_notes": "177.30% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ PPO", "methodology": "fee schedule", "standard_charge_dollar": 124.26, "additional_payer_notes": "177.30% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon Medicare", "methodology": "fee schedule", "standard_charge_dollar": 33.32, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Military Tricare", "methodology": "fee schedule", "standard_charge_dollar": 26.66, "additional_payer_notes": "80.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 33.32, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 33.32, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC All Payer (02-01-2023 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 176.0 }, { "payer_name": "UHC", "plan_name": "UHC Oxford (02-01-2023 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 176.0 }, { "payer_name": "UHC - Adhoc", "plan_name": "UHC - Adhoc All Payer", "methodology": "fee schedule", "standard_charge_dollar": 176.0 }, { "payer_name": "UHC - Adhoc", "plan_name": "UHC - Adhoc Oxford", "methodology": "fee schedule", "standard_charge_dollar": 176.0 }, { "payer_name": "Wellcare", "plan_name": "Wellcare Insurance Exchange", "methodology": "fee schedule", "standard_charge_dollar": 44.98, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 33.32, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup Medicare", "methodology": "fee schedule", "standard_charge_dollar": 33.32, "additional_payer_notes": "100.00% of Medicare Rates" } ] } ] }, { "description": "Hc Incision & Drain Pilonidal Cyst Simpl", "code_information": [ { "code": "10080", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 2888.35, "discounted_cash": 837.0, "minimum": 551.386, "maximum": 13848.0, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 1774.76, "additional_payer_notes": "212.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medical Rental Network", "methodology": "fee schedule", "standard_charge_dollar": 1774.76, "additional_payer_notes": "212.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 837.15, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "ALLY-ALIGN (FKA SPARTAN PLAN NJ, INC.)", "plan_name": "ALLY-ALIGN (FKA SPARTAN PLAN NJ, INC.)", "methodology": "fee schedule", "standard_charge_dollar": 879.01, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Americhoice (UHC)", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 837.15, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Amerihealth", "plan_name": "Amerihealth Medicare", "methodology": "fee schedule", "standard_charge_dollar": 837.15, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 1230.19, "additional_payer_notes": "146.95% of Medicare Rates" }, { "payer_name": "Clover Health", "plan_name": "Clover Medicare", "methodology": "fee schedule", "standard_charge_dollar": 837.15, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Coventry", "plan_name": "Coventry Auto", "methodology": "fee schedule", "standard_charge_dollar": 1674.3, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Coventry", "plan_name": "Coventry Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 1674.3, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "fee schedule", "standard_charge_dollar": 1172.01, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Fairprice Healthcare Holdings", "plan_name": "Fairprice Healthcare Holdings", "methodology": "fee schedule", "standard_charge_dollar": 1339.44, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ HMO POS", "methodology": "fee schedule", "standard_charge_dollar": 1484.27, "additional_payer_notes": "177.30% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ Indemnity", "methodology": "fee schedule", "standard_charge_dollar": 1484.27, "additional_payer_notes": "177.30% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ PPO", "methodology": "fee schedule", "standard_charge_dollar": 1484.27, "additional_payer_notes": "177.30% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon Medicare", "methodology": "fee schedule", "standard_charge_dollar": 837.15, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Military Tricare", "methodology": "fee schedule", "standard_charge_dollar": 669.72, "additional_payer_notes": "80.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 837.15, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 837.15, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC All Payer (02-01-2023 to 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 2888.35 }, { "payer_name": "UHC", "plan_name": "UHC Oxford (02-01-2023 to 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 2297.0 }, { "payer_name": "UHC - Adhoc", "plan_name": "UHC - Adhoc All Payer", "methodology": "case rate", "standard_charge_dollar": 2888.35 }, { "payer_name": "UHC - Adhoc", "plan_name": "UHC - Adhoc Oxford", "methodology": "case rate", "standard_charge_dollar": 2367.0 }, { "payer_name": "Wellcare", "plan_name": "Wellcare Insurance Exchange", "methodology": "fee schedule", "standard_charge_dollar": 1130.15, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 837.15, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellchoice", "plan_name": "WELLCHOICE HMO of NJ (Empire) Commercial (HMO / HMO POS, PPO)", "methodology": "case rate", "standard_charge_dollar": 1715.0 }, { "payer_name": "Wellchoice", "plan_name": "WELLCHOICE HMO of NJ (Empire) Commercial (Indemnity)", "methodology": "case rate", "standard_charge_dollar": 1978.0 }, { "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup Medicare", "methodology": "fee schedule", "standard_charge_dollar": 837.15, "additional_payer_notes": "100.00% of Medicare Rates" } ] } ] }, { "description": "ACUTE MYOCARDIAL INFARCTION, EXPIRED WITH MCC", "code_information": [ { "code": "283", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 24447.0, "minimum": 11269.15, "maximum": 44250.4818, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "case rate", "standard_charge_dollar": 44250.48, "additional_payer_notes": "181.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medical Rental Network", "methodology": "case rate", "standard_charge_dollar": 44250.48, "additional_payer_notes": "181.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "case rate", "standard_charge_dollar": 19937.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "ALLY-ALIGN (FKA SPARTAN PLAN NJ, INC.)", "plan_name": "ALLY-ALIGN (FKA SPARTAN PLAN NJ, INC.)", "methodology": "case rate", "standard_charge_dollar": 25670.17, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Americhoice (UHC)", "plan_name": "UHC Medicare", "methodology": "case rate", "standard_charge_dollar": 19937.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Amerihealth", "plan_name": "Amerihealth Medicare", "methodology": "case rate", "standard_charge_dollar": 19937.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Commercial", "methodology": "case rate", "standard_charge_dollar": 28979.1 }, { "payer_name": "Clover Health", "plan_name": "Clover Medicare", "methodology": "case rate", "standard_charge_dollar": 19937.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Coventry", "plan_name": "Coventry Auto", "methodology": "case rate", "standard_charge_dollar": 41561.23, "additional_payer_notes": "170.00% of Medicare Rates" }, { "payer_name": "Coventry", "plan_name": "Coventry Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 41561.23, "additional_payer_notes": "170.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "case rate", "standard_charge_dollar": 31782.11, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Fairprice Healthcare Holdings", "plan_name": "Fairprice Healthcare Holdings", "methodology": "case rate", "standard_charge_dollar": 39116.45, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon Medicare", "methodology": "case rate", "standard_charge_dollar": 19937.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon NJ Health Medicaid", "methodology": "case rate", "standard_charge_dollar": 11269.15 }, { "payer_name": "Humana", "plan_name": "Humana Military Tricare", "methodology": "case rate", "standard_charge_dollar": 19558.22, "additional_payer_notes": "80.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 24447.78, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 37063.0 }, { "payer_name": "UBH", "plan_name": "UBH Medicare", "methodology": "case rate", "standard_charge_dollar": 19937.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC All Payer (02-01-2023 to 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 33388.36 }, { "payer_name": "UHC", "plan_name": "UHC Oxford (02-01-2023 to 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 29097.95 }, { "payer_name": "UHC - Adhoc", "plan_name": "UHC - Adhoc All Payer", "methodology": "case rate", "standard_charge_dollar": 35442.45 }, { "payer_name": "UHC - Adhoc", "plan_name": "UHC - Adhoc Oxford", "methodology": "case rate", "standard_charge_dollar": 29985.35 }, { "payer_name": "Wellcare", "plan_name": "Wellcare Insurance Exchange", "methodology": "case rate", "standard_charge_dollar": 33004.5, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "case rate", "standard_charge_dollar": 19937.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup Medicare", "methodology": "case rate", "standard_charge_dollar": 19937.6, "additional_payer_notes": "100.00% of Medicare Rates" } ] } ] }, { "description": "Hc Clsd Treat Mid Humerus Xf Wo Manip", "code_information": [ { "code": "24500", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 839.01, "discounted_cash": 291.0, "minimum": 160.167, "maximum": 839.01, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 618.19, "additional_payer_notes": "212.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medical Rental Network", "methodology": "fee schedule", "standard_charge_dollar": 618.19, "additional_payer_notes": "212.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 291.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "ALLY-ALIGN (FKA SPARTAN PLAN NJ, INC.)", "plan_name": "ALLY-ALIGN (FKA SPARTAN PLAN NJ, INC.)", "methodology": "fee schedule", "standard_charge_dollar": 306.18, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Americhoice (UHC)", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 291.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Amerihealth", "plan_name": "Amerihealth Medicare", "methodology": "fee schedule", "standard_charge_dollar": 291.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 428.51, "additional_payer_notes": "146.95% of Medicare Rates" }, { "payer_name": "Clover Health", "plan_name": "Clover Medicare", "methodology": "fee schedule", "standard_charge_dollar": 291.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Coventry", "plan_name": "Coventry Auto", "methodology": "fee schedule", "standard_charge_dollar": 583.2, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Coventry", "plan_name": "Coventry Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 583.2, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "fee schedule", "standard_charge_dollar": 408.24, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Fairprice Healthcare Holdings", "plan_name": "Fairprice Healthcare Holdings", "methodology": "fee schedule", "standard_charge_dollar": 466.56, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ HMO POS", "methodology": "fee schedule", "standard_charge_dollar": 517.01, "additional_payer_notes": "177.30% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ Indemnity", "methodology": "fee schedule", "standard_charge_dollar": 517.01, "additional_payer_notes": "177.30% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ PPO", "methodology": "fee schedule", "standard_charge_dollar": 517.01, "additional_payer_notes": "177.30% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon Medicare", "methodology": "fee schedule", "standard_charge_dollar": 291.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Military Tricare", "methodology": "fee schedule", "standard_charge_dollar": 233.28, "additional_payer_notes": "80.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 291.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 291.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC All Payer (02-01-2023 to 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 839.01 }, { "payer_name": "UHC", "plan_name": "UHC Oxford (02-01-2023 to 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 839.01 }, { "payer_name": "UHC - Adhoc", "plan_name": "UHC - Adhoc All Payer", "methodology": "case rate", "standard_charge_dollar": 839.01 }, { "payer_name": "UHC - Adhoc", "plan_name": "UHC - Adhoc Oxford", "methodology": "case rate", "standard_charge_dollar": 839.01 }, { "payer_name": "Wellcare", "plan_name": "Wellcare Insurance Exchange", "methodology": "fee schedule", "standard_charge_dollar": 393.66, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 291.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup Medicare", "methodology": "fee schedule", "standard_charge_dollar": 291.6, "additional_payer_notes": "100.00% of Medicare Rates" } ] } ] }, { "description": "Hc Percut Biopsy, Abdominal Mass", "code_information": [ { "code": "49180", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 6655.86, "discounted_cash": 1952.0, "minimum": 1270.6037, "maximum": 5324.688, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 4139.36, "additional_payer_notes": "212.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medical Rental Network", "methodology": "fee schedule", "standard_charge_dollar": 4139.36, "additional_payer_notes": "212.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1952.53, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "ALLY-ALIGN (FKA SPARTAN PLAN NJ, INC.)", "plan_name": "ALLY-ALIGN (FKA SPARTAN PLAN NJ, INC.)", "methodology": "fee schedule", "standard_charge_dollar": 2050.16, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Americhoice (UHC)", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1952.53, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Amerihealth", "plan_name": "Amerihealth Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1952.53, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 2869.24, "additional_payer_notes": "146.95% of Medicare Rates" }, { "payer_name": "Clover Health", "plan_name": "Clover Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1952.53, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Coventry", "plan_name": "Coventry Auto", "methodology": "fee schedule", "standard_charge_dollar": 3905.06, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Coventry", "plan_name": "Coventry Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 3905.06, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "fee schedule", "standard_charge_dollar": 2733.54, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Fairprice Healthcare Holdings", "plan_name": "Fairprice Healthcare Holdings", "methodology": "fee schedule", "standard_charge_dollar": 3124.05, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ HMO POS", "methodology": "fee schedule", "standard_charge_dollar": 3461.84, "additional_payer_notes": "177.30% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ Indemnity", "methodology": "fee schedule", "standard_charge_dollar": 3461.84, "additional_payer_notes": "177.30% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ PPO", "methodology": "fee schedule", "standard_charge_dollar": 3461.84, "additional_payer_notes": "177.30% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1952.53, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Military Tricare", "methodology": "fee schedule", "standard_charge_dollar": 1562.02, "additional_payer_notes": "80.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1952.53, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 1952.53, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC All Payer (02-01-2023 to 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 3912.0 }, { "payer_name": "UHC", "plan_name": "UHC Oxford (02-01-2023 to 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 3676.0 }, { "payer_name": "UHC - Adhoc", "plan_name": "UHC - Adhoc All Payer", "methodology": "case rate", "standard_charge_dollar": 4153.0 }, { "payer_name": "UHC - Adhoc", "plan_name": "UHC - Adhoc Oxford", "methodology": "case rate", "standard_charge_dollar": 3788.0 }, { "payer_name": "Wellcare", "plan_name": "Wellcare Insurance Exchange", "methodology": "fee schedule", "standard_charge_dollar": 2635.92, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1952.53, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellchoice", "plan_name": "WELLCHOICE HMO of NJ (Empire) Commercial (HMO / HMO POS, PPO)", "methodology": "case rate", "standard_charge_dollar": 1715.0 }, { "payer_name": "Wellchoice", "plan_name": "WELLCHOICE HMO of NJ (Empire) Commercial (Indemnity)", "methodology": "case rate", "standard_charge_dollar": 1978.0 }, { "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1952.53, "additional_payer_notes": "100.00% of Medicare Rates" } ] } ] }, { "description": "Hc Perq Plcmt Access Biliary Tree & Sm Bwl, New", "code_information": [ { "code": "47541", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 15546.7, "discounted_cash": 7653.0, "minimum": 1715.0, "maximum": 15546.7, "payers_information": [ { "payer_name": "Wellchoice", "plan_name": "WELLCHOICE HMO of NJ (Empire) Commercial (Indemnity)", "methodology": "case rate", "standard_charge_dollar": 1978.0 }, { "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup Medicare", "methodology": "fee schedule", "standard_charge_dollar": 7653.38, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 15546.7, "additional_payer_notes": "212.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medical Rental Network", "methodology": "fee schedule", "standard_charge_dollar": 15546.7, "additional_payer_notes": "212.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 7653.38, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "ALLY-ALIGN (FKA SPARTAN PLAN NJ, INC.)", "plan_name": "ALLY-ALIGN (FKA SPARTAN PLAN NJ, INC.)", "methodology": "fee schedule", "standard_charge_dollar": 8036.05, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Americhoice (UHC)", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 7653.38, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Amerihealth", "plan_name": "Amerihealth Medicare", "methodology": "fee schedule", "standard_charge_dollar": 7653.38, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 11246.64, "additional_payer_notes": "146.95% of Medicare Rates" }, { "payer_name": "Clover Health", "plan_name": "Clover Medicare", "methodology": "fee schedule", "standard_charge_dollar": 7653.38, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Coventry", "plan_name": "Coventry Auto", "methodology": "fee schedule", "standard_charge_dollar": 15306.76, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Coventry", "plan_name": "Coventry Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 15306.76, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "fee schedule", "standard_charge_dollar": 10714.73, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Fairprice Healthcare Holdings", "plan_name": "Fairprice Healthcare Holdings", "methodology": "fee schedule", "standard_charge_dollar": 12245.41, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ HMO POS", "methodology": "fee schedule", "standard_charge_dollar": 13569.44, "additional_payer_notes": "177.30% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ Indemnity", "methodology": "fee schedule", "standard_charge_dollar": 13569.44, "additional_payer_notes": "177.30% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ PPO", "methodology": "fee schedule", "standard_charge_dollar": 13569.44, "additional_payer_notes": "177.30% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon Medicare", "methodology": "fee schedule", "standard_charge_dollar": 7653.38, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Military Tricare", "methodology": "fee schedule", "standard_charge_dollar": 6122.7, "additional_payer_notes": "80.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 7653.38, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 7653.38, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC All Payer (02-01-2023 to 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 5378.0 }, { "payer_name": "UHC", "plan_name": "UHC Oxford (02-01-2023 to 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 5169.0 }, { "payer_name": "UHC - Adhoc", "plan_name": "UHC - Adhoc All Payer", "methodology": "case rate", "standard_charge_dollar": 5709.0 }, { "payer_name": "UHC - Adhoc", "plan_name": "UHC - Adhoc Oxford", "methodology": "case rate", "standard_charge_dollar": 5327.0 }, { "payer_name": "Wellcare", "plan_name": "Wellcare Insurance Exchange", "methodology": "fee schedule", "standard_charge_dollar": 10332.06, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 7653.38, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellchoice", "plan_name": "WELLCHOICE HMO of NJ (Empire) Commercial (HMO / HMO POS, PPO)", "methodology": "case rate", "standard_charge_dollar": 1715.0 } ] } ] }, { "description": "HIV W ONE SIGNIF HIV COND OR WO SIGNIF RELATED COND - SOI : 2", "code_information": [ { "code": "8942", "type": "APR-DRG" } ], "standard_charges": [ { "setting": "inpatient", "minimum": 8814.41, "maximum": 9695.85, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Better Health - Medi Medi", "methodology": "case rate", "standard_charge_dollar": 9695.85, "additional_payer_notes": "110% of State Medicaid Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Better Health Medicaid", "methodology": "case rate", "standard_charge_dollar": 9695.85, "additional_payer_notes": "110% of State Medicaid Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "case rate", "standard_charge_dollar": 8814.41, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "UBH", "plan_name": "UBH Medicaid", "methodology": "case rate", "standard_charge_dollar": 8814.41, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicaid (02/01/2023 to 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 8990.7, "additional_payer_notes": "102% of State Medicaid Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicaid", "methodology": "case rate", "standard_charge_dollar": 8814.41, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup Medicaid", "methodology": "case rate", "standard_charge_dollar": 8814.41, "additional_payer_notes": "100% of State Medicaid Rates" } ] } ] }, { "description": "RECTAL RESECTION WITH CC", "code_information": [ { "code": "333", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 28624.0, "minimum": 12037.83, "maximum": 51809.9468, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "case rate", "standard_charge_dollar": 51809.95, "additional_payer_notes": "181.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medical Rental Network", "methodology": "case rate", "standard_charge_dollar": 51809.95, "additional_payer_notes": "181.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "case rate", "standard_charge_dollar": 23291.2, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "ALLY-ALIGN (FKA SPARTAN PLAN NJ, INC.)", "plan_name": "ALLY-ALIGN (FKA SPARTAN PLAN NJ, INC.)", "methodology": "case rate", "standard_charge_dollar": 30055.49, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Americhoice (UHC)", "plan_name": "UHC Medicare", "methodology": "case rate", "standard_charge_dollar": 23291.2, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Amerihealth", "plan_name": "Amerihealth Medicare", "methodology": "case rate", "standard_charge_dollar": 23291.2, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Commercial", "methodology": "case rate", "standard_charge_dollar": 34266.39 }, { "payer_name": "Clover Health", "plan_name": "Clover Medicare", "methodology": "case rate", "standard_charge_dollar": 23291.2, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Coventry", "plan_name": "Coventry Auto", "methodology": "case rate", "standard_charge_dollar": 48661.28, "additional_payer_notes": "170.00% of Medicare Rates" }, { "payer_name": "Coventry", "plan_name": "Coventry Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 48661.28, "additional_payer_notes": "170.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "case rate", "standard_charge_dollar": 37211.56, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Fairprice Healthcare Holdings", "plan_name": "Fairprice Healthcare Holdings", "methodology": "case rate", "standard_charge_dollar": 45798.85, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon Medicare", "methodology": "case rate", "standard_charge_dollar": 23291.2, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon NJ Health Medicaid", "methodology": "case rate", "standard_charge_dollar": 12037.83 }, { "payer_name": "Humana", "plan_name": "Humana Military Tricare", "methodology": "case rate", "standard_charge_dollar": 22899.42, "additional_payer_notes": "80.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 28624.28, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 44475.0 }, { "payer_name": "UBH", "plan_name": "UBH Medicare", "methodology": "case rate", "standard_charge_dollar": 23291.2, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC All Payer (02-01-2023 to 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 39480.12 }, { "payer_name": "UHC", "plan_name": "UHC Oxford (02-01-2023 to 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 34406.92 }, { "payer_name": "UHC - Adhoc", "plan_name": "UHC - Adhoc All Payer", "methodology": "case rate", "standard_charge_dollar": 41908.98 }, { "payer_name": "UHC - Adhoc", "plan_name": "UHC - Adhoc Oxford", "methodology": "case rate", "standard_charge_dollar": 35456.22 }, { "payer_name": "Wellcare", "plan_name": "Wellcare Insurance Exchange", "methodology": "case rate", "standard_charge_dollar": 38642.78, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "case rate", "standard_charge_dollar": 23291.2, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup Medicare", "methodology": "case rate", "standard_charge_dollar": 23291.2, "additional_payer_notes": "100.00% of Medicare Rates" } ] } ] }, { "description": "Hc Myocardial Imaging Pet Metabolic Evaluation", "code_information": [ { "code": "78459", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 6355.0, "discounted_cash": 1530.0, "minimum": 934.96, "maximum": 5401.75, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 3244.72, "additional_payer_notes": "212.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medical Rental Network", "methodology": "fee schedule", "standard_charge_dollar": 3244.72, "additional_payer_notes": "212.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1530.53, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "ALLY-ALIGN (FKA SPARTAN PLAN NJ, INC.)", "plan_name": "ALLY-ALIGN (FKA SPARTAN PLAN NJ, INC.)", "methodology": "fee schedule", "standard_charge_dollar": 1607.06, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Americhoice (UHC)", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1530.53, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Amerihealth", "plan_name": "Amerihealth HMO", "methodology": "fee schedule", "standard_charge_dollar": 934.96 }, { "payer_name": "Amerihealth", "plan_name": "Amerihealth Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1530.53, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 2249.11, "additional_payer_notes": "146.95% of Medicare Rates" }, { "payer_name": "Clover Health", "plan_name": "Clover Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1530.53, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Coventry", "plan_name": "Coventry Auto", "methodology": "fee schedule", "standard_charge_dollar": 3061.06, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Coventry", "plan_name": "Coventry Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 3061.06, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "fee schedule", "standard_charge_dollar": 2142.74, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Fairprice Healthcare Holdings", "plan_name": "Fairprice Healthcare Holdings", "methodology": "fee schedule", "standard_charge_dollar": 2448.85, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ HMO POS", "methodology": "fee schedule", "standard_charge_dollar": 2713.63, "additional_payer_notes": "177.30% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ Indemnity", "methodology": "fee schedule", "standard_charge_dollar": 2713.63, "additional_payer_notes": "177.30% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ PPO", "methodology": "fee schedule", "standard_charge_dollar": 2713.63, "additional_payer_notes": "177.30% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1530.53, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Military Tricare", "methodology": "fee schedule", "standard_charge_dollar": 1224.42, "additional_payer_notes": "80.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1530.53, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 1530.53, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC All Payer (02-01-2023 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 1958.91 }, { "payer_name": "UHC", "plan_name": "UHC Oxford (02-01-2023 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 1958.91 }, { "payer_name": "UHC - Adhoc", "plan_name": "UHC - Adhoc All Payer", "methodology": "fee schedule", "standard_charge_dollar": 1305.94 }, { "payer_name": "UHC - Adhoc", "plan_name": "UHC - Adhoc Oxford", "methodology": "fee schedule", "standard_charge_dollar": 1305.94 }, { "payer_name": "Wellcare", "plan_name": "Wellcare Insurance Exchange", "methodology": "fee schedule", "standard_charge_dollar": 2066.22, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1530.53, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1530.53, "additional_payer_notes": "100.00% of Medicare Rates" } ] } ] }, { "description": "OTHER SKIN, SUBCUTANEOUS TISSUE & RELATED PROCEDURES - SOI : 4", "code_information": [ { "code": "3644", "type": "APR-DRG" } ], "standard_charges": [ { "setting": "inpatient", "minimum": 36168.87, "maximum": 39785.76, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Better Health - Medi Medi", "methodology": "case rate", "standard_charge_dollar": 39785.76, "additional_payer_notes": "110% of State Medicaid Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Better Health Medicaid", "methodology": "case rate", "standard_charge_dollar": 39785.76, "additional_payer_notes": "110% of State Medicaid Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "case rate", "standard_charge_dollar": 36168.87, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "UBH", "plan_name": "UBH Medicaid", "methodology": "case rate", "standard_charge_dollar": 36168.87, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicaid (02/01/2023 to 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 36892.25, "additional_payer_notes": "102% of State Medicaid Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicaid", "methodology": "case rate", "standard_charge_dollar": 36168.87, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup Medicaid", "methodology": "case rate", "standard_charge_dollar": 36168.87, "additional_payer_notes": "100% of State Medicaid Rates" } ] } ] }, { "description": "VIRAL MENINGITIS - SOI : 3", "code_information": [ { "code": "0513", "type": "APR-DRG" } ], "standard_charges": [ { "setting": "inpatient", "minimum": 15344.61, "maximum": 16879.08, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Better Health - Medi Medi", "methodology": "case rate", "standard_charge_dollar": 16879.08, "additional_payer_notes": "110% of State Medicaid Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Better Health Medicaid", "methodology": "case rate", "standard_charge_dollar": 16879.08, "additional_payer_notes": "110% of State Medicaid Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "case rate", "standard_charge_dollar": 15344.61, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "UBH", "plan_name": "UBH Medicaid", "methodology": "case rate", "standard_charge_dollar": 15344.61, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicaid (02/01/2023 to 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 15651.51, "additional_payer_notes": "102% of State Medicaid Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicaid", "methodology": "case rate", "standard_charge_dollar": 15344.61, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup Medicaid", "methodology": "case rate", "standard_charge_dollar": 15344.61, "additional_payer_notes": "100% of State Medicaid Rates" } ] } ] }, { "description": "Hc Heart/Lung Resuscitation (Cpr)", "code_information": [ { "code": "92950", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 1288.54, "discounted_cash": 255.0, "minimum": 204.208, "maximum": 1288.54, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 541.15, "additional_payer_notes": "212.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medical Rental Network", "methodology": "fee schedule", "standard_charge_dollar": 541.15, "additional_payer_notes": "212.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 255.26, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "ALLY-ALIGN (FKA SPARTAN PLAN NJ, INC.)", "plan_name": "ALLY-ALIGN (FKA SPARTAN PLAN NJ, INC.)", "methodology": "fee schedule", "standard_charge_dollar": 268.02, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Americhoice (UHC)", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 255.26, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Amerihealth", "plan_name": "Amerihealth Medicare", "methodology": "fee schedule", "standard_charge_dollar": 255.26, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 375.1, "additional_payer_notes": "146.95% of Medicare Rates" }, { "payer_name": "Clover Health", "plan_name": "Clover Medicare", "methodology": "fee schedule", "standard_charge_dollar": 255.26, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Coventry", "plan_name": "Coventry Auto", "methodology": "fee schedule", "standard_charge_dollar": 510.52, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Coventry", "plan_name": "Coventry Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 510.52, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "fee schedule", "standard_charge_dollar": 357.36, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Fairprice Healthcare Holdings", "plan_name": "Fairprice Healthcare Holdings", "methodology": "fee schedule", "standard_charge_dollar": 408.42, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ HMO POS", "methodology": "fee schedule", "standard_charge_dollar": 452.58, "additional_payer_notes": "177.30% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ Indemnity", "methodology": "fee schedule", "standard_charge_dollar": 452.58, "additional_payer_notes": "177.30% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ PPO", "methodology": "fee schedule", "standard_charge_dollar": 452.58, "additional_payer_notes": "177.30% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon Medicare", "methodology": "fee schedule", "standard_charge_dollar": 255.26, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Military Tricare", "methodology": "fee schedule", "standard_charge_dollar": 204.21, "additional_payer_notes": "80.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 255.26, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 255.26, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC All Payer (02-01-2023 to 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 1288.54 }, { "payer_name": "UHC", "plan_name": "UHC Oxford (02-01-2023 to 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 1288.54 }, { "payer_name": "UHC - Adhoc", "plan_name": "UHC - Adhoc All Payer", "methodology": "case rate", "standard_charge_dollar": 1288.54 }, { "payer_name": "UHC - Adhoc", "plan_name": "UHC - Adhoc Oxford", "methodology": "case rate", "standard_charge_dollar": 1288.54 }, { "payer_name": "Wellcare", "plan_name": "Wellcare Insurance Exchange", "methodology": "fee schedule", "standard_charge_dollar": 344.6, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 255.26, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellchoice", "plan_name": "WELLCHOICE HMO of NJ (Empire) Commercial (HMO / HMO POS, PPO)", "methodology": "case rate", "standard_charge_dollar": 1288.54 }, { "payer_name": "Wellchoice", "plan_name": "WELLCHOICE HMO of NJ (Empire) Commercial (Indemnity)", "methodology": "case rate", "standard_charge_dollar": 1288.54 }, { "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup Medicare", "methodology": "fee schedule", "standard_charge_dollar": 255.26, "additional_payer_notes": "100.00% of Medicare Rates" } ] } ] }, { "description": "Hc Tobacco Cessation Asymptomatic 3-10 Min", "code_information": [ { "code": "99406", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 106.0, "discounted_cash": 44.0, "minimum": 20.2354, "maximum": 166.9, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 93.89, "additional_payer_notes": "212.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medical Rental Network", "methodology": "fee schedule", "standard_charge_dollar": 93.89, "additional_payer_notes": "212.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 44.29, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "ALLY-ALIGN (FKA SPARTAN PLAN NJ, INC.)", "plan_name": "ALLY-ALIGN (FKA SPARTAN PLAN NJ, INC.)", "methodology": "fee schedule", "standard_charge_dollar": 46.5, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Americhoice (UHC)", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 44.29, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Amerihealth", "plan_name": "Amerihealth Medicare", "methodology": "fee schedule", "standard_charge_dollar": 44.29, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 65.08, "additional_payer_notes": "146.95% of Medicare Rates" }, { "payer_name": "Clover Health", "plan_name": "Clover Medicare", "methodology": "fee schedule", "standard_charge_dollar": 44.29, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Coventry", "plan_name": "Coventry Auto", "methodology": "fee schedule", "standard_charge_dollar": 88.58, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Coventry", "plan_name": "Coventry Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 88.58, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "fee schedule", "standard_charge_dollar": 62.01, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Fairprice Healthcare Holdings", "plan_name": "Fairprice Healthcare Holdings", "methodology": "fee schedule", "standard_charge_dollar": 70.86, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ HMO POS", "methodology": "fee schedule", "standard_charge_dollar": 78.53, "additional_payer_notes": "177.30% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ Indemnity", "methodology": "fee schedule", "standard_charge_dollar": 78.53, "additional_payer_notes": "177.30% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ PPO", "methodology": "fee schedule", "standard_charge_dollar": 78.53, "additional_payer_notes": "177.30% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon Medicare", "methodology": "fee schedule", "standard_charge_dollar": 44.29, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Military Tricare", "methodology": "fee schedule", "standard_charge_dollar": 35.43, "additional_payer_notes": "80.00% of Medicare Rates" }, { "payer_name": "Keenan", "plan_name": "Keenan", "methodology": "percent of total billed charges", "standard_charge_percentage": 30.0, "median_amount": 50.07, "10th_percentile": 50.07, "90th_percentile": 50.07, "count": "1 through 10" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 44.29, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 44.29, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC All Payer (02-01-2023 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 106.0 }, { "payer_name": "UHC", "plan_name": "UHC Medicaid (02/01/2023 to 12-31-2026)", "methodology": "percent of total billed charges", "standard_charge_percentage": 19.47, "median_amount": 31.75, "10th_percentile": 31.75, "90th_percentile": 31.75, "count": "1 through 10" }, { "payer_name": "UHC", "plan_name": "UHC Oxford (02-01-2023 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 106.0 }, { "payer_name": "UHC - Adhoc", "plan_name": "UHC - Adhoc All Payer", "methodology": "fee schedule", "standard_charge_dollar": 106.0 }, { "payer_name": "UHC - Adhoc", "plan_name": "UHC - Adhoc Oxford", "methodology": "fee schedule", "standard_charge_dollar": 106.0 }, { "payer_name": "Wellcare", "plan_name": "Wellcare Insurance Exchange", "methodology": "fee schedule", "standard_charge_dollar": 59.79, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 44.29, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup Medicaid", "methodology": "percent of total billed charges", "standard_charge_percentage": 19.09, "median_amount": 31.13, "10th_percentile": 31.13, "90th_percentile": 31.13, "count": "1 through 10" }, { "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup Medicare", "methodology": "fee schedule", "standard_charge_dollar": 44.29, "additional_payer_notes": "100.00% of Medicare Rates" } ] } ] }, { "description": "Hc Circumcision Age >28 Days", "code_information": [ { "code": "54161", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 6121.42, "discounted_cash": 2471.0, "minimum": 1168.5791, "maximum": 13851.04, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 5239.07, "additional_payer_notes": "212.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medical Rental Network", "methodology": "fee schedule", "standard_charge_dollar": 5239.07, "additional_payer_notes": "212.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2471.26, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "ALLY-ALIGN (FKA SPARTAN PLAN NJ, INC.)", "plan_name": "ALLY-ALIGN (FKA SPARTAN PLAN NJ, INC.)", "methodology": "fee schedule", "standard_charge_dollar": 2594.82, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Americhoice (UHC)", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2471.26, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Amerihealth", "plan_name": "Amerihealth Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2471.26, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 3631.52, "additional_payer_notes": "146.95% of Medicare Rates" }, { "payer_name": "Clover Health", "plan_name": "Clover Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2471.26, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Coventry", "plan_name": "Coventry Auto", "methodology": "fee schedule", "standard_charge_dollar": 4942.52, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Coventry", "plan_name": "Coventry Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 4942.52, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "fee schedule", "standard_charge_dollar": 3459.76, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Fairprice Healthcare Holdings", "plan_name": "Fairprice Healthcare Holdings", "methodology": "fee schedule", "standard_charge_dollar": 3954.02, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ HMO POS", "methodology": "fee schedule", "standard_charge_dollar": 4381.54, "additional_payer_notes": "177.30% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ Indemnity", "methodology": "fee schedule", "standard_charge_dollar": 4381.54, "additional_payer_notes": "177.30% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ PPO", "methodology": "fee schedule", "standard_charge_dollar": 4381.54, "additional_payer_notes": "177.30% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2471.26, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Military Tricare", "methodology": "fee schedule", "standard_charge_dollar": 1977.01, "additional_payer_notes": "80.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2471.26, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 2471.26, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC All Payer (02-01-2023 to 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 4415.0 }, { "payer_name": "UHC", "plan_name": "UHC Oxford (02-01-2023 to 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 4020.0 }, { "payer_name": "UHC - Adhoc", "plan_name": "UHC - Adhoc All Payer", "methodology": "case rate", "standard_charge_dollar": 4687.0 }, { "payer_name": "UHC - Adhoc", "plan_name": "UHC - Adhoc Oxford", "methodology": "case rate", "standard_charge_dollar": 4143.0 }, { "payer_name": "Wellcare", "plan_name": "Wellcare Insurance Exchange", "methodology": "fee schedule", "standard_charge_dollar": 3336.2, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2471.26, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellchoice", "plan_name": "WELLCHOICE HMO of NJ (Empire) Commercial (HMO / HMO POS, PPO)", "methodology": "case rate", "standard_charge_dollar": 1715.0 }, { "payer_name": "Wellchoice", "plan_name": "WELLCHOICE HMO of NJ (Empire) Commercial (Indemnity)", "methodology": "case rate", "standard_charge_dollar": 1978.0 }, { "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2471.26, "additional_payer_notes": "100.00% of Medicare Rates" } ] } ] }, { "description": "Removal of toe lesions", "code_information": [ { "code": "28092", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 30292.5, "discounted_cash": 1900.0, "minimum": 1520.776, "maximum": 24234.0, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 4030.06, "additional_payer_notes": "212.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medical Rental Network", "methodology": "fee schedule", "standard_charge_dollar": 4030.06, "additional_payer_notes": "212.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1900.97, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "ALLY-ALIGN (FKA SPARTAN PLAN NJ, INC.)", "plan_name": "ALLY-ALIGN (FKA SPARTAN PLAN NJ, INC.)", "methodology": "fee schedule", "standard_charge_dollar": 1996.02, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Americhoice (UHC)", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1900.97, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Amerihealth", "plan_name": "Amerihealth Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1900.97, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 2793.48, "additional_payer_notes": "146.95% of Medicare Rates" }, { "payer_name": "Clover Health", "plan_name": "Clover Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1900.97, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Coventry", "plan_name": "Coventry Auto", "methodology": "fee schedule", "standard_charge_dollar": 3801.94, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Coventry", "plan_name": "Coventry Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 3801.94, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "fee schedule", "standard_charge_dollar": 2661.36, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Fairprice Healthcare Holdings", "plan_name": "Fairprice Healthcare Holdings", "methodology": "fee schedule", "standard_charge_dollar": 3041.55, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ HMO POS", "methodology": "fee schedule", "standard_charge_dollar": 3370.42, "additional_payer_notes": "177.30% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ Indemnity", "methodology": "fee schedule", "standard_charge_dollar": 3370.42, "additional_payer_notes": "177.30% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ PPO", "methodology": "fee schedule", "standard_charge_dollar": 3370.42, "additional_payer_notes": "177.30% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1900.97, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Military Tricare", "methodology": "fee schedule", "standard_charge_dollar": 1520.78, "additional_payer_notes": "80.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1900.97, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 1900.97, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC All Payer (02-01-2023 to 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 4415.0 }, { "payer_name": "UHC", "plan_name": "UHC Oxford (02-01-2023 to 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 4020.0 }, { "payer_name": "UHC - Adhoc", "plan_name": "UHC - Adhoc All Payer", "methodology": "case rate", "standard_charge_dollar": 4687.0 }, { "payer_name": "UHC - Adhoc", "plan_name": "UHC - Adhoc Oxford", "methodology": "case rate", "standard_charge_dollar": 4143.0 }, { "payer_name": "Wellcare", "plan_name": "Wellcare Insurance Exchange", "methodology": "fee schedule", "standard_charge_dollar": 2566.31, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1900.97, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellchoice", "plan_name": "WELLCHOICE HMO of NJ (Empire) Commercial (HMO / HMO POS, PPO)", "methodology": "case rate", "standard_charge_dollar": 1715.0 }, { "payer_name": "Wellchoice", "plan_name": "WELLCHOICE HMO of NJ (Empire) Commercial (Indemnity)", "methodology": "case rate", "standard_charge_dollar": 1978.0 }, { "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1900.97, "additional_payer_notes": "100.00% of Medicare Rates" } ] } ] }, { "description": "DISORDERS OF PANCREAS EXCEPT MALIGNANCY - SOI : 4", "code_information": [ { "code": "2824", "type": "APR-DRG" } ], "standard_charges": [ { "setting": "inpatient", "minimum": 28994.15, "maximum": 31893.57, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Better Health - Medi Medi", "methodology": "case rate", "standard_charge_dollar": 31893.57, "additional_payer_notes": "110% of State Medicaid Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Better Health Medicaid", "methodology": "case rate", "standard_charge_dollar": 31893.57, "additional_payer_notes": "110% of State Medicaid Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "case rate", "standard_charge_dollar": 28994.15, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "UBH", "plan_name": "UBH Medicaid", "methodology": "case rate", "standard_charge_dollar": 28994.15, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicaid (02/01/2023 to 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 29574.04, "additional_payer_notes": "102% of State Medicaid Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicaid", "methodology": "case rate", "standard_charge_dollar": 28994.15, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup Medicaid", "methodology": "case rate", "standard_charge_dollar": 28994.15, "additional_payer_notes": "100% of State Medicaid Rates" } ] } ] }, { "description": "Exc Thigh/Knee Tum Dep 5Cm/>", "code_information": [ { "code": "27339", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 30780.0, "discounted_cash": 3433.0, "minimum": 1715.0, "maximum": 24624.0, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 7280.0, "additional_payer_notes": "212.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medical Rental Network", "methodology": "fee schedule", "standard_charge_dollar": 7280.0, "additional_payer_notes": "212.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3433.96, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "ALLY-ALIGN (FKA SPARTAN PLAN NJ, INC.)", "plan_name": "ALLY-ALIGN (FKA SPARTAN PLAN NJ, INC.)", "methodology": "fee schedule", "standard_charge_dollar": 3605.66, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Americhoice (UHC)", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3433.96, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Amerihealth", "plan_name": "Amerihealth Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3433.96, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 5046.2, "additional_payer_notes": "146.95% of Medicare Rates" }, { "payer_name": "Clover Health", "plan_name": "Clover Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3433.96, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Coventry", "plan_name": "Coventry Auto", "methodology": "fee schedule", "standard_charge_dollar": 6867.92, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Coventry", "plan_name": "Coventry Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 6867.92, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "fee schedule", "standard_charge_dollar": 4807.54, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Fairprice Healthcare Holdings", "plan_name": "Fairprice Healthcare Holdings", "methodology": "fee schedule", "standard_charge_dollar": 5494.34, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ HMO POS", "methodology": "fee schedule", "standard_charge_dollar": 6088.41, "additional_payer_notes": "177.30% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ Indemnity", "methodology": "fee schedule", "standard_charge_dollar": 6088.41, "additional_payer_notes": "177.30% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ PPO", "methodology": "fee schedule", "standard_charge_dollar": 6088.41, "additional_payer_notes": "177.30% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3433.96, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Military Tricare", "methodology": "fee schedule", "standard_charge_dollar": 2747.17, "additional_payer_notes": "80.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3433.96, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 3433.96, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC All Payer (02-01-2023 to 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 4415.0 }, { "payer_name": "UHC", "plan_name": "UHC Oxford (02-01-2023 to 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 4020.0 }, { "payer_name": "UHC - Adhoc", "plan_name": "UHC - Adhoc All Payer", "methodology": "case rate", "standard_charge_dollar": 4687.0 }, { "payer_name": "UHC - Adhoc", "plan_name": "UHC - Adhoc Oxford", "methodology": "case rate", "standard_charge_dollar": 4143.0 }, { "payer_name": "Wellcare", "plan_name": "Wellcare Insurance Exchange", "methodology": "fee schedule", "standard_charge_dollar": 4635.85, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3433.96, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellchoice", "plan_name": "WELLCHOICE HMO of NJ (Empire) Commercial (HMO / HMO POS, PPO)", "methodology": "case rate", "standard_charge_dollar": 1715.0 }, { "payer_name": "Wellchoice", "plan_name": "WELLCHOICE HMO of NJ (Empire) Commercial (Indemnity)", "methodology": "case rate", "standard_charge_dollar": 1978.0 }, { "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3433.96, "additional_payer_notes": "100.00% of Medicare Rates" } ] } ] }, { "description": "OTHER ANEMIA & DISORDERS OF BLOOD & BLOOD-FORMING ORGANS - SOI : 2", "code_information": [ { "code": "6632", "type": "APR-DRG" } ], "standard_charges": [ { "setting": "inpatient", "minimum": 8613.29, "maximum": 9474.62, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Better Health - Medi Medi", "methodology": "case rate", "standard_charge_dollar": 9474.62, "additional_payer_notes": "110% of State Medicaid Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Better Health Medicaid", "methodology": "case rate", "standard_charge_dollar": 9474.62, "additional_payer_notes": "110% of State Medicaid Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "case rate", "standard_charge_dollar": 8613.29, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "UBH", "plan_name": "UBH Medicaid", "methodology": "case rate", "standard_charge_dollar": 8613.29, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicaid (02/01/2023 to 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 8785.55, "additional_payer_notes": "102% of State Medicaid Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicaid", "methodology": "case rate", "standard_charge_dollar": 8613.29, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup Medicaid", "methodology": "case rate", "standard_charge_dollar": 8613.29, "additional_payer_notes": "100% of State Medicaid Rates" } ] } ] }, { "description": "Hc Esphgoscopy Flx W/Band Ligation Esophgl Varices", "code_information": [ { "code": "43205", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 5529.07, "discounted_cash": 2268.0, "minimum": 1055.4995, "maximum": 4809.3048, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 4809.3, "additional_payer_notes": "212.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medical Rental Network", "methodology": "fee schedule", "standard_charge_dollar": 4809.3, "additional_payer_notes": "212.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2268.54, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "ALLY-ALIGN (FKA SPARTAN PLAN NJ, INC.)", "plan_name": "ALLY-ALIGN (FKA SPARTAN PLAN NJ, INC.)", "methodology": "fee schedule", "standard_charge_dollar": 2381.97, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Americhoice (UHC)", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2268.54, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Amerihealth", "plan_name": "Amerihealth Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2268.54, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 3333.62, "additional_payer_notes": "146.95% of Medicare Rates" }, { "payer_name": "Clover Health", "plan_name": "Clover Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2268.54, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Coventry", "plan_name": "Coventry Auto", "methodology": "fee schedule", "standard_charge_dollar": 4537.08, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Coventry", "plan_name": "Coventry Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 4537.08, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "fee schedule", "standard_charge_dollar": 3175.96, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Fairprice Healthcare Holdings", "plan_name": "Fairprice Healthcare Holdings", "methodology": "fee schedule", "standard_charge_dollar": 3629.66, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ HMO POS", "methodology": "fee schedule", "standard_charge_dollar": 4022.12, "additional_payer_notes": "177.30% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ Indemnity", "methodology": "fee schedule", "standard_charge_dollar": 4022.12, "additional_payer_notes": "177.30% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ PPO", "methodology": "fee schedule", "standard_charge_dollar": 4022.12, "additional_payer_notes": "177.30% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2268.54, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Military Tricare", "methodology": "fee schedule", "standard_charge_dollar": 1814.83, "additional_payer_notes": "80.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2268.54, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 2268.54, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC All Payer (02-01-2023 to 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 3912.0 }, { "payer_name": "UHC", "plan_name": "UHC Oxford (02-01-2023 to 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 3676.0 }, { "payer_name": "UHC - Adhoc", "plan_name": "UHC - Adhoc All Payer", "methodology": "case rate", "standard_charge_dollar": 4153.0 }, { "payer_name": "UHC - Adhoc", "plan_name": "UHC - Adhoc Oxford", "methodology": "case rate", "standard_charge_dollar": 3788.0 }, { "payer_name": "Wellcare", "plan_name": "Wellcare Insurance Exchange", "methodology": "fee schedule", "standard_charge_dollar": 3062.53, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2268.54, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2268.54, "additional_payer_notes": "100.00% of Medicare Rates" } ] } ] }, { "description": "Hc Electrolyte Panel", "code_information": [ { "code": "80051", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 98.0, "discounted_cash": 7.0, "minimum": 4.21, "maximum": 83.3, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 14.86, "additional_payer_notes": "212.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medical Rental Network", "methodology": "fee schedule", "standard_charge_dollar": 14.86, "additional_payer_notes": "212.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 7.01, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "ALLY-ALIGN (FKA SPARTAN PLAN NJ, INC.)", "plan_name": "ALLY-ALIGN (FKA SPARTAN PLAN NJ, INC.)", "methodology": "fee schedule", "standard_charge_dollar": 7.36, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Americhoice (UHC)", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 7.01, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Amerihealth", "plan_name": "Amerihealth Medicare", "methodology": "fee schedule", "standard_charge_dollar": 7.01, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 10.16, "additional_payer_notes": "Laboratory - 145.00% of Medicare Rates" }, { "payer_name": "Clover Health", "plan_name": "Clover Medicare", "methodology": "fee schedule", "standard_charge_dollar": 7.01, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Coventry", "plan_name": "Coventry Auto", "methodology": "fee schedule", "standard_charge_dollar": 14.02, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Coventry", "plan_name": "Coventry Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 14.02, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "fee schedule", "standard_charge_dollar": 9.81, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Fairprice Healthcare Holdings", "plan_name": "Fairprice Healthcare Holdings", "methodology": "fee schedule", "standard_charge_dollar": 8.41, "additional_payer_notes": "Laboratory - 120.00% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ HMO POS", "methodology": "fee schedule", "standard_charge_dollar": 69.19, "additional_payer_notes": "177.30% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ Indemnity", "methodology": "fee schedule", "standard_charge_dollar": 69.19, "additional_payer_notes": "177.30% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ PPO", "methodology": "fee schedule", "standard_charge_dollar": 69.19, "additional_payer_notes": "177.30% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon Medicare", "methodology": "fee schedule", "standard_charge_dollar": 7.01, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Military Tricare", "methodology": "fee schedule", "standard_charge_dollar": 5.61, "additional_payer_notes": "80.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 7.01, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 7.01, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC All Payer (02-01-2023 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 4.21 }, { "payer_name": "UHC", "plan_name": "UHC Medicaid (02/01/2023 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 5.61 }, { "payer_name": "UHC", "plan_name": "UHC Oxford (02-01-2023 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 4.21 }, { "payer_name": "UHC - Adhoc", "plan_name": "UHC - Adhoc All Payer", "methodology": "fee schedule", "standard_charge_dollar": 7.01 }, { "payer_name": "UHC - Adhoc", "plan_name": "UHC - Adhoc Oxford", "methodology": "fee schedule", "standard_charge_dollar": 7.01 }, { "payer_name": "Wellcare", "plan_name": "Wellcare Insurance Exchange", "methodology": "fee schedule", "standard_charge_dollar": 9.46, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 7.01, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup Medicare", "methodology": "fee schedule", "standard_charge_dollar": 7.01, "additional_payer_notes": "100.00% of Medicare Rates" } ] } ] }, { "description": "CONTUSION, OPEN WOUND & OTHER TRAUMA TO SKIN & SUBCUTANEOUS TISSUE - SOI : 3", "code_information": [ { "code": "3843", "type": "APR-DRG" } ], "standard_charges": [ { "setting": "inpatient", "minimum": 12894.18, "maximum": 14183.59, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Better Health - Medi Medi", "methodology": "case rate", "standard_charge_dollar": 14183.59, "additional_payer_notes": "110% of State Medicaid Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Better Health Medicaid", "methodology": "case rate", "standard_charge_dollar": 14183.59, "additional_payer_notes": "110% of State Medicaid Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "case rate", "standard_charge_dollar": 12894.18, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "UBH", "plan_name": "UBH Medicaid", "methodology": "case rate", "standard_charge_dollar": 12894.18, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicaid (02/01/2023 to 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 13152.06, "additional_payer_notes": "102% of State Medicaid Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicaid", "methodology": "case rate", "standard_charge_dollar": 12894.18, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup Medicaid", "methodology": "case rate", "standard_charge_dollar": 12894.18, "additional_payer_notes": "100% of State Medicaid Rates" } ] } ] }, { "description": "Hc (Sup Shell C1769) Guide Wire", "code_information": [ { "code": "C1769", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "payers_information": [ { "payer_name": "Horizon", "plan_name": "Horizon NJ Health Medicaid", "methodology": "percent of total billed charges", "standard_charge_percentage": 19.58, "median_amount": 251.05, "10th_percentile": 65.24, "90th_percentile": 1400.3, "count": "69" }, { "payer_name": "UHC", "plan_name": "UHC Medicaid (02/01/2023 to 12-31-2026)", "methodology": "percent of total billed charges", "standard_charge_percentage": 19.47, "median_amount": 94.25, "10th_percentile": 30.27, "90th_percentile": 1613.85, "count": "18" }, { "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup Medicaid", "methodology": "percent of total billed charges", "standard_charge_percentage": 19.09, "median_amount": 239.13, "10th_percentile": 29.68, "90th_percentile": 733.41, "count": "17" } ] } ] }, { "description": "Hc Repr Wnd Intrmd Face <2.5 Cm", "code_information": [ { "code": "12051", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 1170.71, "discounted_cash": 480.0, "minimum": 223.4885, "maximum": 13848.0, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 1018.83, "additional_payer_notes": "212.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medical Rental Network", "methodology": "fee schedule", "standard_charge_dollar": 1018.83, "additional_payer_notes": "212.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 480.58, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "ALLY-ALIGN (FKA SPARTAN PLAN NJ, INC.)", "plan_name": "ALLY-ALIGN (FKA SPARTAN PLAN NJ, INC.)", "methodology": "fee schedule", "standard_charge_dollar": 504.61, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Americhoice (UHC)", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 480.58, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Amerihealth", "plan_name": "Amerihealth Medicare", "methodology": "fee schedule", "standard_charge_dollar": 480.58, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 706.21, "additional_payer_notes": "146.95% of Medicare Rates" }, { "payer_name": "Clover Health", "plan_name": "Clover Medicare", "methodology": "fee schedule", "standard_charge_dollar": 480.58, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Coventry", "plan_name": "Coventry Auto", "methodology": "fee schedule", "standard_charge_dollar": 961.16, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Coventry", "plan_name": "Coventry Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 961.16, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "fee schedule", "standard_charge_dollar": 672.81, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Fairprice Healthcare Holdings", "plan_name": "Fairprice Healthcare Holdings", "methodology": "fee schedule", "standard_charge_dollar": 768.93, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ HMO POS", "methodology": "fee schedule", "standard_charge_dollar": 852.07, "additional_payer_notes": "177.30% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ Indemnity", "methodology": "fee schedule", "standard_charge_dollar": 852.07, "additional_payer_notes": "177.30% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ PPO", "methodology": "fee schedule", "standard_charge_dollar": 852.07, "additional_payer_notes": "177.30% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon Medicare", "methodology": "fee schedule", "standard_charge_dollar": 480.58, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Military Tricare", "methodology": "fee schedule", "standard_charge_dollar": 384.46, "additional_payer_notes": "80.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 480.58, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 480.58, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC All Payer (02-01-2023 to 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 1170.71 }, { "payer_name": "UHC", "plan_name": "UHC Oxford (02-01-2023 to 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 1170.71 }, { "payer_name": "UHC - Adhoc", "plan_name": "UHC - Adhoc All Payer", "methodology": "case rate", "standard_charge_dollar": 1170.71 }, { "payer_name": "UHC - Adhoc", "plan_name": "UHC - Adhoc Oxford", "methodology": "case rate", "standard_charge_dollar": 1170.71 }, { "payer_name": "Wellcare", "plan_name": "Wellcare Insurance Exchange", "methodology": "fee schedule", "standard_charge_dollar": 648.78, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 480.58, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellchoice", "plan_name": "WELLCHOICE HMO of NJ (Empire) Commercial (HMO / HMO POS, PPO)", "methodology": "case rate", "standard_charge_dollar": 1170.71 }, { "payer_name": "Wellchoice", "plan_name": "WELLCHOICE HMO of NJ (Empire) Commercial (Indemnity)", "methodology": "case rate", "standard_charge_dollar": 1170.71 }, { "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup Medicare", "methodology": "fee schedule", "standard_charge_dollar": 480.58, "additional_payer_notes": "100.00% of Medicare Rates" } ] } ] }, { "description": "OTHER OPEN CRANIOTOMY- SOI : 3", "code_information": [ { "code": "0273", "type": "APR-DRG" } ], "standard_charges": [ { "setting": "inpatient", "minimum": 37463.05, "maximum": 41209.35, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Better Health - Medi Medi", "methodology": "case rate", "standard_charge_dollar": 41209.35, "additional_payer_notes": "110% of State Medicaid Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Better Health Medicaid", "methodology": "case rate", "standard_charge_dollar": 41209.35, "additional_payer_notes": "110% of State Medicaid Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "case rate", "standard_charge_dollar": 37463.05, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "UBH", "plan_name": "UBH Medicaid", "methodology": "case rate", "standard_charge_dollar": 37463.05, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicaid (02/01/2023 to 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 38212.31, "additional_payer_notes": "102% of State Medicaid Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicaid", "methodology": "case rate", "standard_charge_dollar": 37463.05, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup Medicaid", "methodology": "case rate", "standard_charge_dollar": 37463.05, "additional_payer_notes": "100% of State Medicaid Rates" } ] } ] }, { "description": "Hc Infect Agent Dna/Rna Influenza First 2 Types", "code_information": [ { "code": "87502", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 800.0, "discounted_cash": 95.0, "minimum": 57.48, "maximum": 680.0, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 203.1, "additional_payer_notes": "212.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medical Rental Network", "methodology": "fee schedule", "standard_charge_dollar": 203.1, "additional_payer_notes": "212.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 95.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "ALLY-ALIGN (FKA SPARTAN PLAN NJ, INC.)", "plan_name": "ALLY-ALIGN (FKA SPARTAN PLAN NJ, INC.)", "methodology": "fee schedule", "standard_charge_dollar": 100.59, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Americhoice (UHC)", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 95.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Amerihealth", "plan_name": "Amerihealth Medicare", "methodology": "fee schedule", "standard_charge_dollar": 95.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 138.91, "additional_payer_notes": "Laboratory - 145.00% of Medicare Rates" }, { "payer_name": "Clover Health", "plan_name": "Clover Medicare", "methodology": "fee schedule", "standard_charge_dollar": 95.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Coventry", "plan_name": "Coventry Auto", "methodology": "fee schedule", "standard_charge_dollar": 191.6, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Coventry", "plan_name": "Coventry Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 191.6, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "fee schedule", "standard_charge_dollar": 134.12, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Fairprice Healthcare Holdings", "plan_name": "Fairprice Healthcare Holdings", "methodology": "fee schedule", "standard_charge_dollar": 114.96, "additional_payer_notes": "Laboratory - 120.00% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ HMO POS", "methodology": "fee schedule", "standard_charge_dollar": 564.8, "additional_payer_notes": "177.30% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ Indemnity", "methodology": "fee schedule", "standard_charge_dollar": 564.8, "additional_payer_notes": "177.30% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ PPO", "methodology": "fee schedule", "standard_charge_dollar": 564.8, "additional_payer_notes": "177.30% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon Medicare", "methodology": "fee schedule", "standard_charge_dollar": 95.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Military Tricare", "methodology": "fee schedule", "standard_charge_dollar": 76.64, "additional_payer_notes": "80.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 95.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 95.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC All Payer (02-01-2023 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 57.48 }, { "payer_name": "UHC", "plan_name": "UHC Medicaid (02/01/2023 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 76.64 }, { "payer_name": "UHC", "plan_name": "UHC Oxford (02-01-2023 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 57.48 }, { "payer_name": "UHC - Adhoc", "plan_name": "UHC - Adhoc All Payer", "methodology": "fee schedule", "standard_charge_dollar": 95.8 }, { "payer_name": "UHC - Adhoc", "plan_name": "UHC - Adhoc Oxford", "methodology": "fee schedule", "standard_charge_dollar": 95.8 }, { "payer_name": "Wellcare", "plan_name": "Wellcare Insurance Exchange", "methodology": "fee schedule", "standard_charge_dollar": 129.33, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 95.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup Medicare", "methodology": "fee schedule", "standard_charge_dollar": 95.8, "additional_payer_notes": "100.00% of Medicare Rates" } ] } ] }, { "description": "Hc Nm Myocardial Spect Multiple Studies", "code_information": [ { "code": "78452", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 6529.7, "discounted_cash": 1530.0, "minimum": 822.12, "maximum": 5550.245, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 3244.72, "additional_payer_notes": "212.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medical Rental Network", "methodology": "fee schedule", "standard_charge_dollar": 3244.72, "additional_payer_notes": "212.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1530.53, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "ALLY-ALIGN (FKA SPARTAN PLAN NJ, INC.)", "plan_name": "ALLY-ALIGN (FKA SPARTAN PLAN NJ, INC.)", "methodology": "fee schedule", "standard_charge_dollar": 1607.06, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Americhoice (UHC)", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1530.53, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Amerihealth", "plan_name": "Amerihealth HMO", "methodology": "fee schedule", "standard_charge_dollar": 822.12 }, { "payer_name": "Amerihealth", "plan_name": "Amerihealth Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1530.53, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 2249.11, "additional_payer_notes": "146.95% of Medicare Rates" }, { "payer_name": "Clover Health", "plan_name": "Clover Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1530.53, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Coventry", "plan_name": "Coventry Auto", "methodology": "fee schedule", "standard_charge_dollar": 3061.06, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Coventry", "plan_name": "Coventry Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 3061.06, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "fee schedule", "standard_charge_dollar": 2142.74, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Fairprice Healthcare Holdings", "plan_name": "Fairprice Healthcare Holdings", "methodology": "fee schedule", "standard_charge_dollar": 2448.85, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ HMO POS", "methodology": "fee schedule", "standard_charge_dollar": 2713.63, "additional_payer_notes": "177.30% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ Indemnity", "methodology": "fee schedule", "standard_charge_dollar": 2713.63, "additional_payer_notes": "177.30% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ PPO", "methodology": "fee schedule", "standard_charge_dollar": 2713.63, "additional_payer_notes": "177.30% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1530.53, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon NJ Health Medicaid", "methodology": "percent of total billed charges", "standard_charge_percentage": 19.58, "median_amount": 1278.52, "10th_percentile": 1278.52, "90th_percentile": 1278.52, "count": "118" }, { "payer_name": "Humana", "plan_name": "Humana Military Tricare", "methodology": "fee schedule", "standard_charge_dollar": 1224.42, "additional_payer_notes": "80.00% of Medicare Rates" }, { "payer_name": "Keenan", "plan_name": "Keenan", "methodology": "percent of total billed charges", "standard_charge_percentage": 30.0, "median_amount": 2153.62, "10th_percentile": 2088.71, "90th_percentile": 2153.62, "count": "1 through 10" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1530.53, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 1530.53, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC All Payer (02-01-2023 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 1958.91 }, { "payer_name": "UHC", "plan_name": "UHC Medicaid (02/01/2023 to 12-31-2026)", "methodology": "percent of total billed charges", "standard_charge_percentage": 19.47, "median_amount": 1242.15, "10th_percentile": 1242.15, "90th_percentile": 1271.45, "count": "26" }, { "payer_name": "UHC", "plan_name": "UHC Oxford (02-01-2023 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 1958.91 }, { "payer_name": "UHC - Adhoc", "plan_name": "UHC - Adhoc All Payer", "methodology": "fee schedule", "standard_charge_dollar": 1305.94 }, { "payer_name": "UHC - Adhoc", "plan_name": "UHC - Adhoc Oxford", "methodology": "fee schedule", "standard_charge_dollar": 1305.94 }, { "payer_name": "Wellcare", "plan_name": "Wellcare Insurance Exchange", "methodology": "fee schedule", "standard_charge_dollar": 2066.22, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1530.53, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup Medicaid", "methodology": "percent of total billed charges", "standard_charge_percentage": 19.09, "median_amount": 1217.79, "10th_percentile": 1217.79, "90th_percentile": 1217.79, "count": "15" }, { "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1530.53, "additional_payer_notes": "100.00% of Medicare Rates" } ] } ] }, { "description": "Hc Transtelephonic Rhythm Strip Pacemaker Eval", "code_information": [ { "code": "93293", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 202.0, "discounted_cash": 44.0, "minimum": 35.288, "maximum": 202.0, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 93.51, "additional_payer_notes": "212.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medical Rental Network", "methodology": "fee schedule", "standard_charge_dollar": 93.51, "additional_payer_notes": "212.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 44.11, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "ALLY-ALIGN (FKA SPARTAN PLAN NJ, INC.)", "plan_name": "ALLY-ALIGN (FKA SPARTAN PLAN NJ, INC.)", "methodology": "fee schedule", "standard_charge_dollar": 46.32, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Americhoice (UHC)", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 44.11, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Amerihealth", "plan_name": "Amerihealth Medicare", "methodology": "fee schedule", "standard_charge_dollar": 44.11, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 64.82, "additional_payer_notes": "146.95% of Medicare Rates" }, { "payer_name": "Clover Health", "plan_name": "Clover Medicare", "methodology": "fee schedule", "standard_charge_dollar": 44.11, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Coventry", "plan_name": "Coventry Auto", "methodology": "fee schedule", "standard_charge_dollar": 88.22, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Coventry", "plan_name": "Coventry Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 88.22, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "fee schedule", "standard_charge_dollar": 61.75, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Fairprice Healthcare Holdings", "plan_name": "Fairprice Healthcare Holdings", "methodology": "fee schedule", "standard_charge_dollar": 70.58, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ HMO POS", "methodology": "fee schedule", "standard_charge_dollar": 78.21, "additional_payer_notes": "177.30% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ Indemnity", "methodology": "fee schedule", "standard_charge_dollar": 78.21, "additional_payer_notes": "177.30% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ PPO", "methodology": "fee schedule", "standard_charge_dollar": 78.21, "additional_payer_notes": "177.30% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon Medicare", "methodology": "fee schedule", "standard_charge_dollar": 44.11, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Military Tricare", "methodology": "fee schedule", "standard_charge_dollar": 35.29, "additional_payer_notes": "80.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 44.11, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 44.11, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC All Payer (02-01-2023 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 202.0 }, { "payer_name": "UHC", "plan_name": "UHC Oxford (02-01-2023 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 202.0 }, { "payer_name": "UHC - Adhoc", "plan_name": "UHC - Adhoc All Payer", "methodology": "fee schedule", "standard_charge_dollar": 202.0 }, { "payer_name": "UHC - Adhoc", "plan_name": "UHC - Adhoc Oxford", "methodology": "fee schedule", "standard_charge_dollar": 202.0 }, { "payer_name": "Wellcare", "plan_name": "Wellcare Insurance Exchange", "methodology": "fee schedule", "standard_charge_dollar": 59.55, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 44.11, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup Medicare", "methodology": "fee schedule", "standard_charge_dollar": 44.11, "additional_payer_notes": "100.00% of Medicare Rates" } ] } ] }, { "description": "Hc Exc B9 Lesion Mrgn Xcp Sk Tg T/A/L >4.0 Cm", "code_information": [ { "code": "11406", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 4602.72, "discounted_cash": 1952.0, "minimum": 878.6592, "maximum": 12312.0, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 4139.36, "additional_payer_notes": "212.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medical Rental Network", "methodology": "fee schedule", "standard_charge_dollar": 4139.36, "additional_payer_notes": "212.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1952.53, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "ALLY-ALIGN (FKA SPARTAN PLAN NJ, INC.)", "plan_name": "ALLY-ALIGN (FKA SPARTAN PLAN NJ, INC.)", "methodology": "fee schedule", "standard_charge_dollar": 2050.16, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Americhoice (UHC)", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1952.53, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Amerihealth", "plan_name": "Amerihealth Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1952.53, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 2869.24, "additional_payer_notes": "146.95% of Medicare Rates" }, { "payer_name": "Clover Health", "plan_name": "Clover Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1952.53, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Coventry", "plan_name": "Coventry Auto", "methodology": "fee schedule", "standard_charge_dollar": 3905.06, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Coventry", "plan_name": "Coventry Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 3905.06, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "fee schedule", "standard_charge_dollar": 2733.54, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Fairprice Healthcare Holdings", "plan_name": "Fairprice Healthcare Holdings", "methodology": "fee schedule", "standard_charge_dollar": 3124.05, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ HMO POS", "methodology": "fee schedule", "standard_charge_dollar": 3461.84, "additional_payer_notes": "177.30% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ Indemnity", "methodology": "fee schedule", "standard_charge_dollar": 3461.84, "additional_payer_notes": "177.30% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ PPO", "methodology": "fee schedule", "standard_charge_dollar": 3461.84, "additional_payer_notes": "177.30% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1952.53, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Military Tricare", "methodology": "fee schedule", "standard_charge_dollar": 1562.02, "additional_payer_notes": "80.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1952.53, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 1952.53, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC All Payer (02-01-2023 to 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 3912.0 }, { "payer_name": "UHC", "plan_name": "UHC Oxford (02-01-2023 to 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 3676.0 }, { "payer_name": "UHC - Adhoc", "plan_name": "UHC - Adhoc All Payer", "methodology": "case rate", "standard_charge_dollar": 4153.0 }, { "payer_name": "UHC - Adhoc", "plan_name": "UHC - Adhoc Oxford", "methodology": "case rate", "standard_charge_dollar": 3788.0 }, { "payer_name": "Wellcare", "plan_name": "Wellcare Insurance Exchange", "methodology": "fee schedule", "standard_charge_dollar": 2635.92, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1952.53, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellchoice", "plan_name": "WELLCHOICE HMO of NJ (Empire) Commercial (HMO / HMO POS, PPO)", "methodology": "case rate", "standard_charge_dollar": 1715.0 }, { "payer_name": "Wellchoice", "plan_name": "WELLCHOICE HMO of NJ (Empire) Commercial (Indemnity)", "methodology": "case rate", "standard_charge_dollar": 1978.0 }, { "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1952.53, "additional_payer_notes": "100.00% of Medicare Rates" } ] } ] }, { "description": "Hc X-Ray Retrograde Pyelogram", "code_information": [ { "code": "74420", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 1578.79, "discounted_cash": 412.0, "minimum": 183.77, "maximum": 1341.9715, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 874.37, "additional_payer_notes": "212.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medical Rental Network", "methodology": "fee schedule", "standard_charge_dollar": 874.37, "additional_payer_notes": "212.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 412.44, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "ALLY-ALIGN (FKA SPARTAN PLAN NJ, INC.)", "plan_name": "ALLY-ALIGN (FKA SPARTAN PLAN NJ, INC.)", "methodology": "fee schedule", "standard_charge_dollar": 433.06, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Americhoice (UHC)", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 412.44, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Amerihealth", "plan_name": "Amerihealth HMO", "methodology": "fee schedule", "standard_charge_dollar": 183.77 }, { "payer_name": "Amerihealth", "plan_name": "Amerihealth Medicare", "methodology": "fee schedule", "standard_charge_dollar": 412.44, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 606.08, "additional_payer_notes": "146.95% of Medicare Rates" }, { "payer_name": "Clover Health", "plan_name": "Clover Medicare", "methodology": "fee schedule", "standard_charge_dollar": 412.44, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Coventry", "plan_name": "Coventry Auto", "methodology": "fee schedule", "standard_charge_dollar": 824.88, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Coventry", "plan_name": "Coventry Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 824.88, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "fee schedule", "standard_charge_dollar": 577.42, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Fairprice Healthcare Holdings", "plan_name": "Fairprice Healthcare Holdings", "methodology": "fee schedule", "standard_charge_dollar": 659.9, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ HMO POS", "methodology": "fee schedule", "standard_charge_dollar": 731.26, "additional_payer_notes": "177.30% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ Indemnity", "methodology": "fee schedule", "standard_charge_dollar": 731.26, "additional_payer_notes": "177.30% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ PPO", "methodology": "fee schedule", "standard_charge_dollar": 731.26, "additional_payer_notes": "177.30% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon Medicare", "methodology": "fee schedule", "standard_charge_dollar": 412.44, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Military Tricare", "methodology": "fee schedule", "standard_charge_dollar": 329.95, "additional_payer_notes": "80.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 412.44, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 412.44, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC All Payer (02-01-2023 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 552.18 }, { "payer_name": "UHC", "plan_name": "UHC Oxford (02-01-2023 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 552.18 }, { "payer_name": "UHC - Adhoc", "plan_name": "UHC - Adhoc All Payer", "methodology": "fee schedule", "standard_charge_dollar": 368.12 }, { "payer_name": "UHC - Adhoc", "plan_name": "UHC - Adhoc Oxford", "methodology": "fee schedule", "standard_charge_dollar": 368.12 }, { "payer_name": "Wellcare", "plan_name": "Wellcare Insurance Exchange", "methodology": "fee schedule", "standard_charge_dollar": 556.79, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 412.44, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup Medicare", "methodology": "fee schedule", "standard_charge_dollar": 412.44, "additional_payer_notes": "100.00% of Medicare Rates" } ] } ] }, { "description": "Hc Targeted Case Management", "code_information": [ { "code": "T1017", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 76.24, "minimum": 14.5542, "maximum": 76.24, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 20.72, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon NJ Health Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 76.24 }, { "payer_name": "UBH", "plan_name": "UBH Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 76.24 }, { "payer_name": "UHC", "plan_name": "UHC Medicaid (02/01/2023 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 76.24 }, { "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup Medicaid", "methodology": "percent of total billed charges", "standard_charge_percentage": 19.09, "median_amount": 228.72, "10th_percentile": 152.48, "90th_percentile": 304.96, "count": "1 through 10" } ] } ] }, { "description": "AUTOLOGOUS BONE MARROW TRANSPLANT OR T-CELL IMMUNOTHERAPY- SOI : 3", "code_information": [ { "code": "0083", "type": "APR-DRG" } ], "standard_charges": [ { "setting": "inpatient", "minimum": 56161.73, "maximum": 61777.91, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Better Health - Medi Medi", "methodology": "case rate", "standard_charge_dollar": 61777.91, "additional_payer_notes": "110% of State Medicaid Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Better Health Medicaid", "methodology": "case rate", "standard_charge_dollar": 61777.91, "additional_payer_notes": "110% of State Medicaid Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "case rate", "standard_charge_dollar": 56161.73, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "UBH", "plan_name": "UBH Medicaid", "methodology": "case rate", "standard_charge_dollar": 56161.73, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicaid (02/01/2023 to 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 57284.97, "additional_payer_notes": "102% of State Medicaid Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicaid", "methodology": "case rate", "standard_charge_dollar": 56161.73, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup Medicaid", "methodology": "case rate", "standard_charge_dollar": 56161.73, "additional_payer_notes": "100% of State Medicaid Rates" } ] } ] }, { "description": "Hc Assay Of Corticosteroids", "code_information": [ { "code": "83491", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 105.0, "discounted_cash": 17.0, "minimum": 10.74, "maximum": 89.25, "payers_information": [ { "payer_name": "Coventry", "plan_name": "Coventry Auto", "methodology": "fee schedule", "standard_charge_dollar": 35.8, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Coventry", "plan_name": "Coventry Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 35.8, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "fee schedule", "standard_charge_dollar": 25.06, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Fairprice Healthcare Holdings", "plan_name": "Fairprice Healthcare Holdings", "methodology": "fee schedule", "standard_charge_dollar": 21.48, "additional_payer_notes": "Laboratory - 120.00% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ HMO POS", "methodology": "fee schedule", "standard_charge_dollar": 74.13, "additional_payer_notes": "177.30% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ Indemnity", "methodology": "fee schedule", "standard_charge_dollar": 74.13, "additional_payer_notes": "177.30% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ PPO", "methodology": "fee schedule", "standard_charge_dollar": 74.13, "additional_payer_notes": "177.30% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon Medicare", "methodology": "fee schedule", "standard_charge_dollar": 17.9, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Military Tricare", "methodology": "fee schedule", "standard_charge_dollar": 14.32, "additional_payer_notes": "80.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 17.9, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 17.9, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC All Payer (02-01-2023 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 10.74 }, { "payer_name": "UHC", "plan_name": "UHC Medicaid (02/01/2023 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 14.32 }, { "payer_name": "UHC", "plan_name": "UHC Oxford (02-01-2023 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 10.74 }, { "payer_name": "UHC - Adhoc", "plan_name": "UHC - Adhoc All Payer", "methodology": "fee schedule", "standard_charge_dollar": 17.9 }, { "payer_name": "UHC - Adhoc", "plan_name": "UHC - Adhoc Oxford", "methodology": "fee schedule", "standard_charge_dollar": 17.9 }, { "payer_name": "Wellcare", "plan_name": "Wellcare Insurance Exchange", "methodology": "fee schedule", "standard_charge_dollar": 24.17, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 17.9, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup Medicare", "methodology": "fee schedule", "standard_charge_dollar": 17.9, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 37.95, "additional_payer_notes": "212.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medical Rental Network", "methodology": "fee schedule", "standard_charge_dollar": 37.95, "additional_payer_notes": "212.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 17.9, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "ALLY-ALIGN (FKA SPARTAN PLAN NJ, INC.)", "plan_name": "ALLY-ALIGN (FKA SPARTAN PLAN NJ, INC.)", "methodology": "fee schedule", "standard_charge_dollar": 18.8, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Americhoice (UHC)", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 17.9, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Amerihealth", "plan_name": "Amerihealth Medicare", "methodology": "fee schedule", "standard_charge_dollar": 17.9, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 25.96, "additional_payer_notes": "Laboratory - 145.00% of Medicare Rates" }, { "payer_name": "Clover Health", "plan_name": "Clover Medicare", "methodology": "fee schedule", "standard_charge_dollar": 17.9, "additional_payer_notes": "100.00% of Medicare Rates" } ] } ] }, { "description": "Hc Cath Plc/Cor Angio Rs/In W Right Heart Cath", "code_information": [ { "code": "93456", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 15296.8, "discounted_cash": 3832.0, "minimum": 2472.0, "maximum": 12237.44, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 8125.18, "additional_payer_notes": "212.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medical Rental Network", "methodology": "fee schedule", "standard_charge_dollar": 8125.18, "additional_payer_notes": "212.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3832.63, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "ALLY-ALIGN (FKA SPARTAN PLAN NJ, INC.)", "plan_name": "ALLY-ALIGN (FKA SPARTAN PLAN NJ, INC.)", "methodology": "fee schedule", "standard_charge_dollar": 4024.26, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Americhoice (UHC)", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3832.63, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Amerihealth", "plan_name": "Amerihealth Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3832.63, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 5632.05, "additional_payer_notes": "146.95% of Medicare Rates" }, { "payer_name": "Clover Health", "plan_name": "Clover Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3832.63, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Coventry", "plan_name": "Coventry Auto", "methodology": "fee schedule", "standard_charge_dollar": 7665.26, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Coventry", "plan_name": "Coventry Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 7665.26, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "fee schedule", "standard_charge_dollar": 5365.68, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Fairprice Healthcare Holdings", "plan_name": "Fairprice Healthcare Holdings", "methodology": "fee schedule", "standard_charge_dollar": 6132.21, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ HMO POS", "methodology": "fee schedule", "standard_charge_dollar": 6795.25, "additional_payer_notes": "177.30% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ Indemnity", "methodology": "fee schedule", "standard_charge_dollar": 6795.25, "additional_payer_notes": "177.30% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ PPO", "methodology": "fee schedule", "standard_charge_dollar": 6795.25, "additional_payer_notes": "177.30% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3832.63, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Military Tricare", "methodology": "fee schedule", "standard_charge_dollar": 3066.1, "additional_payer_notes": "80.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3832.63, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 3832.63, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC All Payer (02-01-2023 to 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 5667.0 }, { "payer_name": "UHC", "plan_name": "UHC Oxford (02-01-2023 to 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 5169.0 }, { "payer_name": "UHC - Adhoc", "plan_name": "UHC - Adhoc All Payer", "methodology": "case rate", "standard_charge_dollar": 6016.0 }, { "payer_name": "UHC - Adhoc", "plan_name": "UHC - Adhoc Oxford", "methodology": "case rate", "standard_charge_dollar": 5327.0 }, { "payer_name": "Wellcare", "plan_name": "Wellcare Insurance Exchange", "methodology": "fee schedule", "standard_charge_dollar": 5174.05, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3832.63, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellchoice", "plan_name": "WELLCHOICE HMO of NJ (Empire) Commercial (HMO / HMO POS, PPO)", "methodology": "case rate", "standard_charge_dollar": 2472.0 }, { "payer_name": "Wellchoice", "plan_name": "WELLCHOICE HMO of NJ (Empire) Commercial (Indemnity)", "methodology": "case rate", "standard_charge_dollar": 2753.0 }, { "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3832.63, "additional_payer_notes": "100.00% of Medicare Rates" } ] } ] }, { "description": "Hc Lipoprotein Bld By Nmr", "code_information": [ { "code": "83704", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 340.0, "discounted_cash": 34.0, "minimum": 20.51, "maximum": 289.0, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 72.48, "additional_payer_notes": "212.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medical Rental Network", "methodology": "fee schedule", "standard_charge_dollar": 72.48, "additional_payer_notes": "212.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 34.19, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "ALLY-ALIGN (FKA SPARTAN PLAN NJ, INC.)", "plan_name": "ALLY-ALIGN (FKA SPARTAN PLAN NJ, INC.)", "methodology": "fee schedule", "standard_charge_dollar": 35.9, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Americhoice (UHC)", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 34.19, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Amerihealth", "plan_name": "Amerihealth Medicare", "methodology": "fee schedule", "standard_charge_dollar": 34.19, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 49.58, "additional_payer_notes": "Laboratory - 145.00% of Medicare Rates" }, { "payer_name": "Clover Health", "plan_name": "Clover Medicare", "methodology": "fee schedule", "standard_charge_dollar": 34.19, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Coventry", "plan_name": "Coventry Auto", "methodology": "fee schedule", "standard_charge_dollar": 68.38, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Coventry", "plan_name": "Coventry Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 68.38, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "fee schedule", "standard_charge_dollar": 47.87, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Fairprice Healthcare Holdings", "plan_name": "Fairprice Healthcare Holdings", "methodology": "fee schedule", "standard_charge_dollar": 41.03, "additional_payer_notes": "Laboratory - 120.00% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ HMO POS", "methodology": "fee schedule", "standard_charge_dollar": 240.04, "additional_payer_notes": "177.30% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ Indemnity", "methodology": "fee schedule", "standard_charge_dollar": 240.04, "additional_payer_notes": "177.30% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ PPO", "methodology": "fee schedule", "standard_charge_dollar": 240.04, "additional_payer_notes": "177.30% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon Medicare", "methodology": "fee schedule", "standard_charge_dollar": 34.19, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Military Tricare", "methodology": "fee schedule", "standard_charge_dollar": 27.35, "additional_payer_notes": "80.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 34.19, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 34.19, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC All Payer (02-01-2023 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 20.51 }, { "payer_name": "UHC", "plan_name": "UHC Medicaid (02/01/2023 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 27.35 }, { "payer_name": "UHC", "plan_name": "UHC Oxford (02-01-2023 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 20.51 }, { "payer_name": "UHC - Adhoc", "plan_name": "UHC - Adhoc All Payer", "methodology": "fee schedule", "standard_charge_dollar": 34.19 }, { "payer_name": "UHC - Adhoc", "plan_name": "UHC - Adhoc Oxford", "methodology": "fee schedule", "standard_charge_dollar": 34.19 }, { "payer_name": "Wellcare", "plan_name": "Wellcare Insurance Exchange", "methodology": "fee schedule", "standard_charge_dollar": 46.16, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 34.19, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup Medicare", "methodology": "fee schedule", "standard_charge_dollar": 34.19, "additional_payer_notes": "100.00% of Medicare Rates" } ] } ] }, { "description": "Hc Insert Tunneled Cv Cath W/O Port Or Pump", "code_information": [ { "code": "36558", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 13207.6, "discounted_cash": 3732.0, "minimum": 1715.0, "maximum": 10566.08, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 7913.51, "additional_payer_notes": "212.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medical Rental Network", "methodology": "fee schedule", "standard_charge_dollar": 7913.51, "additional_payer_notes": "212.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3732.79, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "ALLY-ALIGN (FKA SPARTAN PLAN NJ, INC.)", "plan_name": "ALLY-ALIGN (FKA SPARTAN PLAN NJ, INC.)", "methodology": "fee schedule", "standard_charge_dollar": 3919.43, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Americhoice (UHC)", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3732.79, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Amerihealth", "plan_name": "Amerihealth Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3732.79, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 5485.33, "additional_payer_notes": "146.95% of Medicare Rates" }, { "payer_name": "Clover Health", "plan_name": "Clover Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3732.79, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Coventry", "plan_name": "Coventry Auto", "methodology": "fee schedule", "standard_charge_dollar": 7465.58, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Coventry", "plan_name": "Coventry Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 7465.58, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "fee schedule", "standard_charge_dollar": 5225.91, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Fairprice Healthcare Holdings", "plan_name": "Fairprice Healthcare Holdings", "methodology": "fee schedule", "standard_charge_dollar": 5972.46, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ HMO POS", "methodology": "fee schedule", "standard_charge_dollar": 6618.24, "additional_payer_notes": "177.30% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ Indemnity", "methodology": "fee schedule", "standard_charge_dollar": 6618.24, "additional_payer_notes": "177.30% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ PPO", "methodology": "fee schedule", "standard_charge_dollar": 6618.24, "additional_payer_notes": "177.30% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3732.79, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Military Tricare", "methodology": "fee schedule", "standard_charge_dollar": 2986.23, "additional_payer_notes": "80.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3732.79, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 3732.79, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC All Payer (02-01-2023 to 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 5378.0 }, { "payer_name": "UHC", "plan_name": "UHC Oxford (02-01-2023 to 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 5169.0 }, { "payer_name": "UHC - Adhoc", "plan_name": "UHC - Adhoc All Payer", "methodology": "case rate", "standard_charge_dollar": 5709.0 }, { "payer_name": "UHC - Adhoc", "plan_name": "UHC - Adhoc Oxford", "methodology": "case rate", "standard_charge_dollar": 5327.0 }, { "payer_name": "Wellcare", "plan_name": "Wellcare Insurance Exchange", "methodology": "fee schedule", "standard_charge_dollar": 5039.27, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3732.79, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellchoice", "plan_name": "WELLCHOICE HMO of NJ (Empire) Commercial (HMO / HMO POS, PPO)", "methodology": "case rate", "standard_charge_dollar": 1715.0 }, { "payer_name": "Wellchoice", "plan_name": "WELLCHOICE HMO of NJ (Empire) Commercial (Indemnity)", "methodology": "case rate", "standard_charge_dollar": 1978.0 }, { "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3732.79, "additional_payer_notes": "100.00% of Medicare Rates" } ] } ] }, { "description": "NEONATE BIRTHWT >2499G W OTHER SIGNIFICANT CONDITION - SOI : 4", "code_information": [ { "code": "6394", "type": "APR-DRG" } ], "standard_charges": [ { "setting": "inpatient", "minimum": 32103.27, "maximum": 35313.6, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Better Health - Medi Medi", "methodology": "case rate", "standard_charge_dollar": 35313.6, "additional_payer_notes": "110% of State Medicaid Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Better Health Medicaid", "methodology": "case rate", "standard_charge_dollar": 35313.6, "additional_payer_notes": "110% of State Medicaid Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "case rate", "standard_charge_dollar": 32103.27, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "UBH", "plan_name": "UBH Medicaid", "methodology": "case rate", "standard_charge_dollar": 32103.27, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicaid (02/01/2023 to 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 32745.34, "additional_payer_notes": "102% of State Medicaid Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicaid", "methodology": "case rate", "standard_charge_dollar": 32103.27, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup Medicaid", "methodology": "case rate", "standard_charge_dollar": 32103.27, "additional_payer_notes": "100% of State Medicaid Rates" } ] } ] }, { "description": "Hc Strapping Knee", "code_information": [ { "code": "29530", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 545.15, "discounted_cash": 157.0, "minimum": 104.0691, "maximum": 545.15, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 333.45, "additional_payer_notes": "212.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medical Rental Network", "methodology": "fee schedule", "standard_charge_dollar": 333.45, "additional_payer_notes": "212.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 157.29, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "ALLY-ALIGN (FKA SPARTAN PLAN NJ, INC.)", "plan_name": "ALLY-ALIGN (FKA SPARTAN PLAN NJ, INC.)", "methodology": "fee schedule", "standard_charge_dollar": 165.15, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Americhoice (UHC)", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 157.29, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Amerihealth", "plan_name": "Amerihealth Medicare", "methodology": "fee schedule", "standard_charge_dollar": 157.29, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 231.14, "additional_payer_notes": "146.95% of Medicare Rates" }, { "payer_name": "Clover Health", "plan_name": "Clover Medicare", "methodology": "fee schedule", "standard_charge_dollar": 157.29, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Coventry", "plan_name": "Coventry Auto", "methodology": "fee schedule", "standard_charge_dollar": 314.58, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Coventry", "plan_name": "Coventry Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 314.58, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "fee schedule", "standard_charge_dollar": 220.21, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Fairprice Healthcare Holdings", "plan_name": "Fairprice Healthcare Holdings", "methodology": "fee schedule", "standard_charge_dollar": 251.66, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ HMO POS", "methodology": "fee schedule", "standard_charge_dollar": 278.88, "additional_payer_notes": "177.30% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ Indemnity", "methodology": "fee schedule", "standard_charge_dollar": 278.88, "additional_payer_notes": "177.30% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ PPO", "methodology": "fee schedule", "standard_charge_dollar": 278.88, "additional_payer_notes": "177.30% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon Medicare", "methodology": "fee schedule", "standard_charge_dollar": 157.29, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Military Tricare", "methodology": "fee schedule", "standard_charge_dollar": 125.83, "additional_payer_notes": "80.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 157.29, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 157.29, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC All Payer (02-01-2023 to 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 545.15 }, { "payer_name": "UHC", "plan_name": "UHC Oxford (02-01-2023 to 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 545.15 }, { "payer_name": "UHC - Adhoc", "plan_name": "UHC - Adhoc All Payer", "methodology": "case rate", "standard_charge_dollar": 545.15 }, { "payer_name": "UHC - Adhoc", "plan_name": "UHC - Adhoc Oxford", "methodology": "case rate", "standard_charge_dollar": 545.15 }, { "payer_name": "Wellcare", "plan_name": "Wellcare Insurance Exchange", "methodology": "fee schedule", "standard_charge_dollar": 212.34, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 157.29, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup Medicare", "methodology": "fee schedule", "standard_charge_dollar": 157.29, "additional_payer_notes": "100.00% of Medicare Rates" } ] } ] }, { "description": "SEPTICEMIA & DISSEMINATED INFECTIONS - SOI : 4", "code_information": [ { "code": "7204", "type": "APR-DRG" } ], "standard_charges": [ { "setting": "inpatient", "minimum": 25217.26, "maximum": 27738.99, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Better Health - Medi Medi", "methodology": "case rate", "standard_charge_dollar": 27738.99, "additional_payer_notes": "110% of State Medicaid Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Better Health Medicaid", "methodology": "case rate", "standard_charge_dollar": 27738.99, "additional_payer_notes": "110% of State Medicaid Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "case rate", "standard_charge_dollar": 25217.26, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "UBH", "plan_name": "UBH Medicaid", "methodology": "case rate", "standard_charge_dollar": 25217.26, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicaid (02/01/2023 to 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 25721.61, "additional_payer_notes": "102% of State Medicaid Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicaid", "methodology": "case rate", "standard_charge_dollar": 25217.26, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup Medicaid", "methodology": "case rate", "standard_charge_dollar": 25217.26, "additional_payer_notes": "100% of State Medicaid Rates" } ] } ] }, { "description": "Hc Ketone Bodies Serum Quantitative", "code_information": [ { "code": "82010", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 130.88, "discounted_cash": 8.0, "minimum": 4.9, "maximum": 111.248, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 17.32, "additional_payer_notes": "212.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medical Rental Network", "methodology": "fee schedule", "standard_charge_dollar": 17.32, "additional_payer_notes": "212.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 8.17, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "ALLY-ALIGN (FKA SPARTAN PLAN NJ, INC.)", "plan_name": "ALLY-ALIGN (FKA SPARTAN PLAN NJ, INC.)", "methodology": "fee schedule", "standard_charge_dollar": 8.58, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Americhoice (UHC)", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 8.17, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Amerihealth", "plan_name": "Amerihealth Medicare", "methodology": "fee schedule", "standard_charge_dollar": 8.17, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 11.85, "additional_payer_notes": "Laboratory - 145.00% of Medicare Rates" }, { "payer_name": "Clover Health", "plan_name": "Clover Medicare", "methodology": "fee schedule", "standard_charge_dollar": 8.17, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Coventry", "plan_name": "Coventry Auto", "methodology": "fee schedule", "standard_charge_dollar": 16.34, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Coventry", "plan_name": "Coventry Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 16.34, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "fee schedule", "standard_charge_dollar": 11.44, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Fairprice Healthcare Holdings", "plan_name": "Fairprice Healthcare Holdings", "methodology": "fee schedule", "standard_charge_dollar": 9.8, "additional_payer_notes": "Laboratory - 120.00% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ HMO POS", "methodology": "fee schedule", "standard_charge_dollar": 92.4, "additional_payer_notes": "177.30% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ Indemnity", "methodology": "fee schedule", "standard_charge_dollar": 92.4, "additional_payer_notes": "177.30% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ PPO", "methodology": "fee schedule", "standard_charge_dollar": 92.4, "additional_payer_notes": "177.30% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon Medicare", "methodology": "fee schedule", "standard_charge_dollar": 8.17, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Military Tricare", "methodology": "fee schedule", "standard_charge_dollar": 6.54, "additional_payer_notes": "80.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 8.17, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 8.17, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC All Payer (02-01-2023 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 4.9 }, { "payer_name": "UHC", "plan_name": "UHC Medicaid (02/01/2023 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 6.54 }, { "payer_name": "UHC", "plan_name": "UHC Oxford (02-01-2023 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 4.9 }, { "payer_name": "UHC - Adhoc", "plan_name": "UHC - Adhoc All Payer", "methodology": "fee schedule", "standard_charge_dollar": 8.17 }, { "payer_name": "UHC - Adhoc", "plan_name": "UHC - Adhoc Oxford", "methodology": "fee schedule", "standard_charge_dollar": 8.17 }, { "payer_name": "Wellcare", "plan_name": "Wellcare Insurance Exchange", "methodology": "fee schedule", "standard_charge_dollar": 11.03, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 8.17, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup Medicaid", "methodology": "percent of total billed charges", "standard_charge_percentage": 19.09, "median_amount": 8.17, "10th_percentile": 8.17, "90th_percentile": 24.99, "count": "1 through 10" }, { "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup Medicare", "methodology": "fee schedule", "standard_charge_dollar": 8.17, "additional_payer_notes": "100.00% of Medicare Rates" } ] } ] }, { "description": "OTHER COMPLICATIONS OF TREATMENT - SOI : 3", "code_information": [ { "code": "8133", "type": "APR-DRG" } ], "standard_charges": [ { "setting": "inpatient", "minimum": 12294.76, "maximum": 13524.24, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Better Health - Medi Medi", "methodology": "case rate", "standard_charge_dollar": 13524.24, "additional_payer_notes": "110% of State Medicaid Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Better Health Medicaid", "methodology": "case rate", "standard_charge_dollar": 13524.24, "additional_payer_notes": "110% of State Medicaid Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "case rate", "standard_charge_dollar": 12294.76, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "UBH", "plan_name": "UBH Medicaid", "methodology": "case rate", "standard_charge_dollar": 12294.76, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicaid (02/01/2023 to 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 12540.66, "additional_payer_notes": "102% of State Medicaid Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicaid", "methodology": "case rate", "standard_charge_dollar": 12294.76, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup Medicaid", "methodology": "case rate", "standard_charge_dollar": 12294.76, "additional_payer_notes": "100% of State Medicaid Rates" } ] } ] }, { "description": "APPENDECTOMY WITHOUT COMPLEX PRINCIPAL DIAGNOSIS - SOI : 1", "code_information": [ { "code": "2341", "type": "APR-DRG" } ], "standard_charges": [ { "setting": "inpatient", "minimum": 10526.19, "maximum": 11578.8, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Better Health - Medi Medi", "methodology": "case rate", "standard_charge_dollar": 11578.8, "additional_payer_notes": "110% of State Medicaid Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Better Health Medicaid", "methodology": "case rate", "standard_charge_dollar": 11578.8, "additional_payer_notes": "110% of State Medicaid Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "case rate", "standard_charge_dollar": 10526.19, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "UBH", "plan_name": "UBH Medicaid", "methodology": "case rate", "standard_charge_dollar": 10526.19, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicaid (02/01/2023 to 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 10736.71, "additional_payer_notes": "102% of State Medicaid Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicaid", "methodology": "case rate", "standard_charge_dollar": 10526.19, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup Medicaid", "methodology": "case rate", "standard_charge_dollar": 10526.19, "additional_payer_notes": "100% of State Medicaid Rates" } ] } ] }, { "description": "Hc Duplex Scan Extracranial,Bilat", "code_information": [ { "code": "93880", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 1357.0, "discounted_cash": 282.0, "minimum": 225.656, "maximum": 1337.0, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 597.99, "additional_payer_notes": "212.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medical Rental Network", "methodology": "fee schedule", "standard_charge_dollar": 597.99, "additional_payer_notes": "212.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 282.07, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "ALLY-ALIGN (FKA SPARTAN PLAN NJ, INC.)", "plan_name": "ALLY-ALIGN (FKA SPARTAN PLAN NJ, INC.)", "methodology": "fee schedule", "standard_charge_dollar": 296.17, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Americhoice (UHC)", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 282.07, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Amerihealth", "plan_name": "Amerihealth Medicare", "methodology": "fee schedule", "standard_charge_dollar": 282.07, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 414.5, "additional_payer_notes": "146.95% of Medicare Rates" }, { "payer_name": "Clover Health", "plan_name": "Clover Medicare", "methodology": "fee schedule", "standard_charge_dollar": 282.07, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Coventry", "plan_name": "Coventry Auto", "methodology": "fee schedule", "standard_charge_dollar": 564.14, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Coventry", "plan_name": "Coventry Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 564.14, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "fee schedule", "standard_charge_dollar": 394.9, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Fairprice Healthcare Holdings", "plan_name": "Fairprice Healthcare Holdings", "methodology": "fee schedule", "standard_charge_dollar": 451.31, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ HMO POS", "methodology": "fee schedule", "standard_charge_dollar": 500.11, "additional_payer_notes": "177.30% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ Indemnity", "methodology": "fee schedule", "standard_charge_dollar": 500.11, "additional_payer_notes": "177.30% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ PPO", "methodology": "fee schedule", "standard_charge_dollar": 500.11, "additional_payer_notes": "177.30% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon Medicare", "methodology": "fee schedule", "standard_charge_dollar": 282.07, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon NJ Health Medicaid", "methodology": "percent of total billed charges", "standard_charge_percentage": 19.58, "median_amount": 265.7, "10th_percentile": 265.7, "90th_percentile": 265.7, "count": "1 through 10" }, { "payer_name": "Humana", "plan_name": "Humana Military Tricare", "methodology": "fee schedule", "standard_charge_dollar": 225.66, "additional_payer_notes": "80.00% of Medicare Rates" }, { "payer_name": "Keenan", "plan_name": "Keenan", "methodology": "percent of total billed charges", "standard_charge_percentage": 30.0, "median_amount": 407.1, "10th_percentile": 407.1, "90th_percentile": 637.47, "count": "1 through 10" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 282.07, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 282.07, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC All Payer (02-01-2023 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 1260.0 }, { "payer_name": "UHC", "plan_name": "UHC Medicaid (02/01/2023 to 12-31-2026)", "methodology": "percent of total billed charges", "standard_charge_percentage": 19.47, "median_amount": 258.14, "10th_percentile": 258.14, "90th_percentile": 284.66, "count": "1 through 10" }, { "payer_name": "UHC", "plan_name": "UHC Oxford (02-01-2023 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 1103.0 }, { "payer_name": "UHC - Adhoc", "plan_name": "UHC - Adhoc All Payer", "methodology": "fee schedule", "standard_charge_dollar": 1337.0 }, { "payer_name": "UHC - Adhoc", "plan_name": "UHC - Adhoc Oxford", "methodology": "fee schedule", "standard_charge_dollar": 1115.0 }, { "payer_name": "Wellcare", "plan_name": "Wellcare Insurance Exchange", "methodology": "fee schedule", "standard_charge_dollar": 380.79, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 282.07, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup Medicaid", "methodology": "percent of total billed charges", "standard_charge_percentage": 19.09, "median_amount": 253.08, "10th_percentile": 253.08, "90th_percentile": 253.08, "count": "1 through 10" }, { "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup Medicare", "methodology": "fee schedule", "standard_charge_dollar": 282.07, "additional_payer_notes": "100.00% of Medicare Rates" } ] } ] }, { "description": "Hc Cytomeg Dna Quant", "code_information": [ { "code": "87497", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 525.0, "discounted_cash": 42.0, "minimum": 25.7, "maximum": 446.25, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 90.82, "additional_payer_notes": "212.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medical Rental Network", "methodology": "fee schedule", "standard_charge_dollar": 90.82, "additional_payer_notes": "212.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 42.84, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "ALLY-ALIGN (FKA SPARTAN PLAN NJ, INC.)", "plan_name": "ALLY-ALIGN (FKA SPARTAN PLAN NJ, INC.)", "methodology": "fee schedule", "standard_charge_dollar": 44.98, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Americhoice (UHC)", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 42.84, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Amerihealth", "plan_name": "Amerihealth Medicare", "methodology": "fee schedule", "standard_charge_dollar": 42.84, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 62.12, "additional_payer_notes": "Laboratory - 145.00% of Medicare Rates" }, { "payer_name": "Clover Health", "plan_name": "Clover Medicare", "methodology": "fee schedule", "standard_charge_dollar": 42.84, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Coventry", "plan_name": "Coventry Auto", "methodology": "fee schedule", "standard_charge_dollar": 85.68, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Coventry", "plan_name": "Coventry Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 85.68, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "fee schedule", "standard_charge_dollar": 59.98, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Fairprice Healthcare Holdings", "plan_name": "Fairprice Healthcare Holdings", "methodology": "fee schedule", "standard_charge_dollar": 51.41, "additional_payer_notes": "Laboratory - 120.00% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ HMO POS", "methodology": "fee schedule", "standard_charge_dollar": 370.65, "additional_payer_notes": "177.30% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ Indemnity", "methodology": "fee schedule", "standard_charge_dollar": 370.65, "additional_payer_notes": "177.30% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ PPO", "methodology": "fee schedule", "standard_charge_dollar": 370.65, "additional_payer_notes": "177.30% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon Medicare", "methodology": "fee schedule", "standard_charge_dollar": 42.84, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Military Tricare", "methodology": "fee schedule", "standard_charge_dollar": 34.27, "additional_payer_notes": "80.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 42.84, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 42.84, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC All Payer (02-01-2023 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 25.7 }, { "payer_name": "UHC", "plan_name": "UHC Medicaid (02/01/2023 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 34.27 }, { "payer_name": "UHC", "plan_name": "UHC Oxford (02-01-2023 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 25.7 }, { "payer_name": "UHC - Adhoc", "plan_name": "UHC - Adhoc All Payer", "methodology": "fee schedule", "standard_charge_dollar": 42.84 }, { "payer_name": "UHC - Adhoc", "plan_name": "UHC - Adhoc Oxford", "methodology": "fee schedule", "standard_charge_dollar": 42.84 }, { "payer_name": "Wellcare", "plan_name": "Wellcare Insurance Exchange", "methodology": "fee schedule", "standard_charge_dollar": 57.83, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 42.84, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup Medicare", "methodology": "fee schedule", "standard_charge_dollar": 42.84, "additional_payer_notes": "100.00% of Medicare Rates" } ] } ] }, { "description": "FEMALE REPRODUCTIVE SYSTEM INFECTIONS - SOI : 1", "code_information": [ { "code": "5311", "type": "APR-DRG" } ], "standard_charges": [ { "setting": "inpatient", "minimum": 6171.87, "maximum": 6789.06, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Better Health - Medi Medi", "methodology": "case rate", "standard_charge_dollar": 6789.06, "additional_payer_notes": "110% of State Medicaid Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Better Health Medicaid", "methodology": "case rate", "standard_charge_dollar": 6789.06, "additional_payer_notes": "110% of State Medicaid Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "case rate", "standard_charge_dollar": 6171.87, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "UBH", "plan_name": "UBH Medicaid", "methodology": "case rate", "standard_charge_dollar": 6171.87, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicaid (02/01/2023 to 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 6295.31, "additional_payer_notes": "102% of State Medicaid Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicaid", "methodology": "case rate", "standard_charge_dollar": 6171.87, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup Medicaid", "methodology": "case rate", "standard_charge_dollar": 6171.87, "additional_payer_notes": "100% of State Medicaid Rates" } ] } ] }, { "description": "RADIOTHERAPY", "code_information": [ { "code": "849", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 32868.0, "minimum": 12302.59, "maximum": 59492.8538, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "case rate", "standard_charge_dollar": 59492.85, "additional_payer_notes": "181.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medical Rental Network", "methodology": "case rate", "standard_charge_dollar": 59492.85, "additional_payer_notes": "181.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "case rate", "standard_charge_dollar": 26699.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "ALLY-ALIGN (FKA SPARTAN PLAN NJ, INC.)", "plan_name": "ALLY-ALIGN (FKA SPARTAN PLAN NJ, INC.)", "methodology": "case rate", "standard_charge_dollar": 34512.43, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Americhoice (UHC)", "plan_name": "UHC Medicare", "methodology": "case rate", "standard_charge_dollar": 26699.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Amerihealth", "plan_name": "Amerihealth Medicare", "methodology": "case rate", "standard_charge_dollar": 26699.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Commercial", "methodology": "case rate", "standard_charge_dollar": 39639.99 }, { "payer_name": "Clover Health", "plan_name": "Clover Medicare", "methodology": "case rate", "standard_charge_dollar": 26699.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Coventry", "plan_name": "Coventry Auto", "methodology": "case rate", "standard_charge_dollar": 55877.27, "additional_payer_notes": "170.00% of Medicare Rates" }, { "payer_name": "Coventry", "plan_name": "Coventry Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 55877.27, "additional_payer_notes": "170.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "case rate", "standard_charge_dollar": 42729.67, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Fairprice Healthcare Holdings", "plan_name": "Fairprice Healthcare Holdings", "methodology": "case rate", "standard_charge_dollar": 52590.37, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon Medicare", "methodology": "case rate", "standard_charge_dollar": 26699.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon NJ Health Medicaid", "methodology": "case rate", "standard_charge_dollar": 12302.59 }, { "payer_name": "Humana", "plan_name": "Humana Military Tricare", "methodology": "case rate", "standard_charge_dollar": 26295.18, "additional_payer_notes": "80.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 32868.98, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 38861.3 }, { "payer_name": "UBH", "plan_name": "UBH Medicare", "methodology": "case rate", "standard_charge_dollar": 26699.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC All Payer (02-01-2023 to 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 45671.33 }, { "payer_name": "UHC", "plan_name": "UHC Oxford (02-01-2023 to 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 39802.56 }, { "payer_name": "UHC - Adhoc", "plan_name": "UHC - Adhoc All Payer", "methodology": "case rate", "standard_charge_dollar": 48481.08 }, { "payer_name": "UHC - Adhoc", "plan_name": "UHC - Adhoc Oxford", "methodology": "case rate", "standard_charge_dollar": 41016.41 }, { "payer_name": "Wellcare", "plan_name": "Wellcare Insurance Exchange", "methodology": "case rate", "standard_charge_dollar": 44373.12, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "case rate", "standard_charge_dollar": 26699.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup Medicare", "methodology": "case rate", "standard_charge_dollar": 26699.6, "additional_payer_notes": "100.00% of Medicare Rates" } ] } ] }, { "description": "Hc Nm Brain Imaging Min 4 Static Views W Vascular Flw", "code_information": [ { "code": "78606", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 2447.0, "discounted_cash": 641.0, "minimum": 322.4, "maximum": 2079.95, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 1360.83, "additional_payer_notes": "212.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medical Rental Network", "methodology": "fee schedule", "standard_charge_dollar": 1360.83, "additional_payer_notes": "212.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 641.9, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "ALLY-ALIGN (FKA SPARTAN PLAN NJ, INC.)", "plan_name": "ALLY-ALIGN (FKA SPARTAN PLAN NJ, INC.)", "methodology": "fee schedule", "standard_charge_dollar": 674.0, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Americhoice (UHC)", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 641.9, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Amerihealth", "plan_name": "Amerihealth HMO", "methodology": "fee schedule", "standard_charge_dollar": 322.4 }, { "payer_name": "Amerihealth", "plan_name": "Amerihealth Medicare", "methodology": "fee schedule", "standard_charge_dollar": 641.9, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 943.27, "additional_payer_notes": "146.95% of Medicare Rates" }, { "payer_name": "Clover Health", "plan_name": "Clover Medicare", "methodology": "fee schedule", "standard_charge_dollar": 641.9, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Coventry", "plan_name": "Coventry Auto", "methodology": "fee schedule", "standard_charge_dollar": 1283.8, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Coventry", "plan_name": "Coventry Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 1283.8, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "fee schedule", "standard_charge_dollar": 898.66, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Fairprice Healthcare Holdings", "plan_name": "Fairprice Healthcare Holdings", "methodology": "fee schedule", "standard_charge_dollar": 1027.04, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ HMO POS", "methodology": "fee schedule", "standard_charge_dollar": 1138.09, "additional_payer_notes": "177.30% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ Indemnity", "methodology": "fee schedule", "standard_charge_dollar": 1138.09, "additional_payer_notes": "177.30% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ PPO", "methodology": "fee schedule", "standard_charge_dollar": 1138.09, "additional_payer_notes": "177.30% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon Medicare", "methodology": "fee schedule", "standard_charge_dollar": 641.9, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Military Tricare", "methodology": "fee schedule", "standard_charge_dollar": 513.52, "additional_payer_notes": "80.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 641.9, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 641.9, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC All Payer (02-01-2023 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 734.1 }, { "payer_name": "UHC", "plan_name": "UHC Oxford (02-01-2023 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 734.1 }, { "payer_name": "UHC - Adhoc", "plan_name": "UHC - Adhoc All Payer", "methodology": "fee schedule", "standard_charge_dollar": 489.4 }, { "payer_name": "UHC - Adhoc", "plan_name": "UHC - Adhoc Oxford", "methodology": "fee schedule", "standard_charge_dollar": 489.4 }, { "payer_name": "Wellcare", "plan_name": "Wellcare Insurance Exchange", "methodology": "fee schedule", "standard_charge_dollar": 866.57, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 641.9, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup Medicare", "methodology": "fee schedule", "standard_charge_dollar": 641.9, "additional_payer_notes": "100.00% of Medicare Rates" } ] } ] }, { "description": "Removal of foot foreign body - 28193 - ", "code_information": [ { "code": "28193", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 5770.0, "discounted_cash": 1952.0, "minimum": 1101.493, "maximum": 4616.0, "payers_information": [ { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1952.53, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellchoice", "plan_name": "WELLCHOICE HMO of NJ (Empire) Commercial (HMO / HMO POS, PPO)", "methodology": "case rate", "standard_charge_dollar": 1715.0 }, { "payer_name": "Wellchoice", "plan_name": "WELLCHOICE HMO of NJ (Empire) Commercial (Indemnity)", "methodology": "case rate", "standard_charge_dollar": 1978.0 }, { "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1952.53, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 4139.36, "additional_payer_notes": "212.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medical Rental Network", "methodology": "fee schedule", "standard_charge_dollar": 4139.36, "additional_payer_notes": "212.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1952.53, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "ALLY-ALIGN (FKA SPARTAN PLAN NJ, INC.)", "plan_name": "ALLY-ALIGN (FKA SPARTAN PLAN NJ, INC.)", "methodology": "fee schedule", "standard_charge_dollar": 2050.16, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Americhoice (UHC)", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1952.53, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Amerihealth", "plan_name": "Amerihealth Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1952.53, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 2869.24, "additional_payer_notes": "146.95% of Medicare Rates" }, { "payer_name": "Clover Health", "plan_name": "Clover Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1952.53, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Coventry", "plan_name": "Coventry Auto", "methodology": "fee schedule", "standard_charge_dollar": 3905.06, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Coventry", "plan_name": "Coventry Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 3905.06, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "fee schedule", "standard_charge_dollar": 2733.54, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Fairprice Healthcare Holdings", "plan_name": "Fairprice Healthcare Holdings", "methodology": "fee schedule", "standard_charge_dollar": 3124.05, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ HMO POS", "methodology": "fee schedule", "standard_charge_dollar": 3461.84, "additional_payer_notes": "177.30% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ Indemnity", "methodology": "fee schedule", "standard_charge_dollar": 3461.84, "additional_payer_notes": "177.30% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ PPO", "methodology": "fee schedule", "standard_charge_dollar": 3461.84, "additional_payer_notes": "177.30% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1952.53, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Military Tricare", "methodology": "fee schedule", "standard_charge_dollar": 1562.02, "additional_payer_notes": "80.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1952.53, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 1952.53, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC All Payer (02-01-2023 to 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 3147.0 }, { "payer_name": "UHC", "plan_name": "UHC Oxford (02-01-2023 to 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 2297.0 }, { "payer_name": "UHC - Adhoc", "plan_name": "UHC - Adhoc All Payer", "methodology": "case rate", "standard_charge_dollar": 3341.0 }, { "payer_name": "UHC - Adhoc", "plan_name": "UHC - Adhoc Oxford", "methodology": "case rate", "standard_charge_dollar": 2367.0 }, { "payer_name": "Wellcare", "plan_name": "Wellcare Insurance Exchange", "methodology": "fee schedule", "standard_charge_dollar": 2635.92, "additional_payer_notes": "135.00% of Medicare Rates" } ] } ] }, { "description": "EAR, NOSE, MOUTH, THROAT, CRANIALFACIAL MALIGNANCIES - SOI : 3", "code_information": [ { "code": "1103", "type": "APR-DRG" } ], "standard_charges": [ { "setting": "inpatient", "minimum": 14910.24, "maximum": 16401.26, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Better Health - Medi Medi", "methodology": "case rate", "standard_charge_dollar": 16401.26, "additional_payer_notes": "110% of State Medicaid Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Better Health Medicaid", "methodology": "case rate", "standard_charge_dollar": 16401.26, "additional_payer_notes": "110% of State Medicaid Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "case rate", "standard_charge_dollar": 14910.24, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "UBH", "plan_name": "UBH Medicaid", "methodology": "case rate", "standard_charge_dollar": 14910.24, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicaid (02/01/2023 to 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 15208.44, "additional_payer_notes": "102% of State Medicaid Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicaid", "methodology": "case rate", "standard_charge_dollar": 14910.24, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup Medicaid", "methodology": "case rate", "standard_charge_dollar": 14910.24, "additional_payer_notes": "100% of State Medicaid Rates" } ] } ] }, { "description": "Hc Renal Function Panel", "code_information": [ { "code": "80069", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 125.0, "discounted_cash": 8.0, "minimum": 5.21, "maximum": 106.25, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 18.4, "additional_payer_notes": "212.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medical Rental Network", "methodology": "fee schedule", "standard_charge_dollar": 18.4, "additional_payer_notes": "212.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 8.68, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "ALLY-ALIGN (FKA SPARTAN PLAN NJ, INC.)", "plan_name": "ALLY-ALIGN (FKA SPARTAN PLAN NJ, INC.)", "methodology": "fee schedule", "standard_charge_dollar": 9.11, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Americhoice (UHC)", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 8.68, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Amerihealth", "plan_name": "Amerihealth Medicare", "methodology": "fee schedule", "standard_charge_dollar": 8.68, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 12.59, "additional_payer_notes": "Laboratory - 145.00% of Medicare Rates" }, { "payer_name": "Clover Health", "plan_name": "Clover Medicare", "methodology": "fee schedule", "standard_charge_dollar": 8.68, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Coventry", "plan_name": "Coventry Auto", "methodology": "fee schedule", "standard_charge_dollar": 17.36, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Coventry", "plan_name": "Coventry Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 17.36, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "fee schedule", "standard_charge_dollar": 12.15, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Fairprice Healthcare Holdings", "plan_name": "Fairprice Healthcare Holdings", "methodology": "fee schedule", "standard_charge_dollar": 10.42, "additional_payer_notes": "Laboratory - 120.00% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ HMO POS", "methodology": "fee schedule", "standard_charge_dollar": 88.25, "additional_payer_notes": "177.30% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ Indemnity", "methodology": "fee schedule", "standard_charge_dollar": 88.25, "additional_payer_notes": "177.30% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ PPO", "methodology": "fee schedule", "standard_charge_dollar": 88.25, "additional_payer_notes": "177.30% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon Medicare", "methodology": "fee schedule", "standard_charge_dollar": 8.68, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Military Tricare", "methodology": "fee schedule", "standard_charge_dollar": 6.94, "additional_payer_notes": "80.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 8.68, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 8.68, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC All Payer (02-01-2023 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 5.21 }, { "payer_name": "UHC", "plan_name": "UHC Medicaid (02/01/2023 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 6.94 }, { "payer_name": "UHC", "plan_name": "UHC Oxford (02-01-2023 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 5.21 }, { "payer_name": "UHC - Adhoc", "plan_name": "UHC - Adhoc All Payer", "methodology": "fee schedule", "standard_charge_dollar": 8.68 }, { "payer_name": "UHC - Adhoc", "plan_name": "UHC - Adhoc Oxford", "methodology": "fee schedule", "standard_charge_dollar": 8.68 }, { "payer_name": "Wellcare", "plan_name": "Wellcare Insurance Exchange", "methodology": "fee schedule", "standard_charge_dollar": 11.72, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 8.68, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup Medicare", "methodology": "fee schedule", "standard_charge_dollar": 8.68, "additional_payer_notes": "100.00% of Medicare Rates" } ] } ] }, { "description": "ANTEPARTUM WITH O.R. PROCEDURE- SOI : 4", "code_information": [ { "code": "5474", "type": "APR-DRG" } ], "standard_charges": [ { "setting": "inpatient", "minimum": 29686.38, "maximum": 32655.01, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Better Health - Medi Medi", "methodology": "case rate", "standard_charge_dollar": 32655.01, "additional_payer_notes": "110% of State Medicaid Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Better Health Medicaid", "methodology": "case rate", "standard_charge_dollar": 32655.01, "additional_payer_notes": "110% of State Medicaid Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "case rate", "standard_charge_dollar": 29686.38, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "UBH", "plan_name": "UBH Medicaid", "methodology": "case rate", "standard_charge_dollar": 29686.38, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicaid (02/01/2023 to 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 30280.1, "additional_payer_notes": "102% of State Medicaid Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicaid", "methodology": "case rate", "standard_charge_dollar": 29686.38, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup Medicaid", "methodology": "case rate", "standard_charge_dollar": 29686.38, "additional_payer_notes": "100% of State Medicaid Rates" } ] } ] }, { "description": "Hc Drug Assay Lacosamide", "code_information": [ { "code": "80235", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 250.0, "discounted_cash": 27.0, "minimum": 16.27, "maximum": 212.5, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 57.47, "additional_payer_notes": "212.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medical Rental Network", "methodology": "fee schedule", "standard_charge_dollar": 57.47, "additional_payer_notes": "212.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 27.11, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "ALLY-ALIGN (FKA SPARTAN PLAN NJ, INC.)", "plan_name": "ALLY-ALIGN (FKA SPARTAN PLAN NJ, INC.)", "methodology": "fee schedule", "standard_charge_dollar": 28.47, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Americhoice (UHC)", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 27.11, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Amerihealth", "plan_name": "Amerihealth Medicare", "methodology": "fee schedule", "standard_charge_dollar": 27.11, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 39.31, "additional_payer_notes": "Laboratory - 145.00% of Medicare Rates" }, { "payer_name": "Clover Health", "plan_name": "Clover Medicare", "methodology": "fee schedule", "standard_charge_dollar": 27.11, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Coventry", "plan_name": "Coventry Auto", "methodology": "fee schedule", "standard_charge_dollar": 54.22, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Coventry", "plan_name": "Coventry Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 54.22, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "fee schedule", "standard_charge_dollar": 37.95, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Fairprice Healthcare Holdings", "plan_name": "Fairprice Healthcare Holdings", "methodology": "fee schedule", "standard_charge_dollar": 32.53, "additional_payer_notes": "Laboratory - 120.00% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ HMO POS", "methodology": "fee schedule", "standard_charge_dollar": 176.5, "additional_payer_notes": "177.30% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ Indemnity", "methodology": "fee schedule", "standard_charge_dollar": 176.5, "additional_payer_notes": "177.30% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ PPO", "methodology": "fee schedule", "standard_charge_dollar": 176.5, "additional_payer_notes": "177.30% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon Medicare", "methodology": "fee schedule", "standard_charge_dollar": 27.11, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Military Tricare", "methodology": "fee schedule", "standard_charge_dollar": 21.69, "additional_payer_notes": "80.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 27.11, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 27.11, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC All Payer (02-01-2023 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 16.27 }, { "payer_name": "UHC", "plan_name": "UHC Medicaid (02/01/2023 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 21.69 }, { "payer_name": "UHC", "plan_name": "UHC Oxford (02-01-2023 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 16.27 }, { "payer_name": "UHC - Adhoc", "plan_name": "UHC - Adhoc All Payer", "methodology": "fee schedule", "standard_charge_dollar": 27.11 }, { "payer_name": "UHC - Adhoc", "plan_name": "UHC - Adhoc Oxford", "methodology": "fee schedule", "standard_charge_dollar": 27.11 }, { "payer_name": "Wellcare", "plan_name": "Wellcare Insurance Exchange", "methodology": "fee schedule", "standard_charge_dollar": 36.6, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 27.11, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup Medicare", "methodology": "fee schedule", "standard_charge_dollar": 27.11, "additional_payer_notes": "100.00% of Medicare Rates" } ] } ] }, { "description": "Hc Cath Plc/Cor Angio Rs/I Bypass Angio", "code_information": [ { "code": "93455", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 14052.0, "discounted_cash": 3832.0, "minimum": 2472.0, "maximum": 11241.6, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 8125.18, "additional_payer_notes": "212.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medical Rental Network", "methodology": "fee schedule", "standard_charge_dollar": 8125.18, "additional_payer_notes": "212.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3832.63, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "ALLY-ALIGN (FKA SPARTAN PLAN NJ, INC.)", "plan_name": "ALLY-ALIGN (FKA SPARTAN PLAN NJ, INC.)", "methodology": "fee schedule", "standard_charge_dollar": 4024.26, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Americhoice (UHC)", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3832.63, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Amerihealth", "plan_name": "Amerihealth Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3832.63, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 5632.05, "additional_payer_notes": "146.95% of Medicare Rates" }, { "payer_name": "Clover Health", "plan_name": "Clover Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3832.63, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Coventry", "plan_name": "Coventry Auto", "methodology": "fee schedule", "standard_charge_dollar": 7665.26, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Coventry", "plan_name": "Coventry Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 7665.26, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "fee schedule", "standard_charge_dollar": 5365.68, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Fairprice Healthcare Holdings", "plan_name": "Fairprice Healthcare Holdings", "methodology": "fee schedule", "standard_charge_dollar": 6132.21, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ HMO POS", "methodology": "fee schedule", "standard_charge_dollar": 6795.25, "additional_payer_notes": "177.30% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ Indemnity", "methodology": "fee schedule", "standard_charge_dollar": 6795.25, "additional_payer_notes": "177.30% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ PPO", "methodology": "fee schedule", "standard_charge_dollar": 6795.25, "additional_payer_notes": "177.30% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3832.63, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Military Tricare", "methodology": "fee schedule", "standard_charge_dollar": 3066.1, "additional_payer_notes": "80.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3832.63, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 3832.63, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC All Payer (02-01-2023 to 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 5667.0 }, { "payer_name": "UHC", "plan_name": "UHC Oxford (02-01-2023 to 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 5169.0 }, { "payer_name": "UHC - Adhoc", "plan_name": "UHC - Adhoc All Payer", "methodology": "case rate", "standard_charge_dollar": 6016.0 }, { "payer_name": "UHC - Adhoc", "plan_name": "UHC - Adhoc Oxford", "methodology": "case rate", "standard_charge_dollar": 5327.0 }, { "payer_name": "Wellcare", "plan_name": "Wellcare Insurance Exchange", "methodology": "fee schedule", "standard_charge_dollar": 5174.05, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3832.63, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellchoice", "plan_name": "WELLCHOICE HMO of NJ (Empire) Commercial (HMO / HMO POS, PPO)", "methodology": "case rate", "standard_charge_dollar": 2472.0 }, { "payer_name": "Wellchoice", "plan_name": "WELLCHOICE HMO of NJ (Empire) Commercial (Indemnity)", "methodology": "case rate", "standard_charge_dollar": 2753.0 }, { "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3832.63, "additional_payer_notes": "100.00% of Medicare Rates" } ] } ] }, { "description": "Hc Blood Occult Stool, 1-3 Simult, Non Can Screen", "code_information": [ { "code": "82272", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 21.15, "discounted_cash": 4.0, "minimum": 2.54, "maximum": 17.9775, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 8.97, "additional_payer_notes": "212.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medical Rental Network", "methodology": "fee schedule", "standard_charge_dollar": 8.97, "additional_payer_notes": "212.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 4.23, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "ALLY-ALIGN (FKA SPARTAN PLAN NJ, INC.)", "plan_name": "ALLY-ALIGN (FKA SPARTAN PLAN NJ, INC.)", "methodology": "fee schedule", "standard_charge_dollar": 4.44, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Americhoice (UHC)", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 4.23, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Amerihealth", "plan_name": "Amerihealth Medicare", "methodology": "fee schedule", "standard_charge_dollar": 4.23, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 6.13, "additional_payer_notes": "Laboratory - 145.00% of Medicare Rates" }, { "payer_name": "Clover Health", "plan_name": "Clover Medicare", "methodology": "fee schedule", "standard_charge_dollar": 4.23, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Coventry", "plan_name": "Coventry Auto", "methodology": "fee schedule", "standard_charge_dollar": 8.46, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Coventry", "plan_name": "Coventry Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 8.46, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "fee schedule", "standard_charge_dollar": 5.92, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Fairprice Healthcare Holdings", "plan_name": "Fairprice Healthcare Holdings", "methodology": "fee schedule", "standard_charge_dollar": 5.08, "additional_payer_notes": "Laboratory - 120.00% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ HMO POS", "methodology": "fee schedule", "standard_charge_dollar": 14.93, "additional_payer_notes": "177.30% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ Indemnity", "methodology": "fee schedule", "standard_charge_dollar": 14.93, "additional_payer_notes": "177.30% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ PPO", "methodology": "fee schedule", "standard_charge_dollar": 14.93, "additional_payer_notes": "177.30% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon Medicare", "methodology": "fee schedule", "standard_charge_dollar": 4.23, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Military Tricare", "methodology": "fee schedule", "standard_charge_dollar": 3.38, "additional_payer_notes": "80.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 4.23, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 4.23, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC All Payer (02-01-2023 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 2.54 }, { "payer_name": "UHC", "plan_name": "UHC Medicaid (02/01/2023 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 3.38 }, { "payer_name": "UHC", "plan_name": "UHC Oxford (02-01-2023 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 2.54 }, { "payer_name": "UHC - Adhoc", "plan_name": "UHC - Adhoc All Payer", "methodology": "fee schedule", "standard_charge_dollar": 4.23 }, { "payer_name": "UHC - Adhoc", "plan_name": "UHC - Adhoc Oxford", "methodology": "fee schedule", "standard_charge_dollar": 4.23 }, { "payer_name": "Wellcare", "plan_name": "Wellcare Insurance Exchange", "methodology": "fee schedule", "standard_charge_dollar": 5.71, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 4.23, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup Medicare", "methodology": "fee schedule", "standard_charge_dollar": 4.23, "additional_payer_notes": "100.00% of Medicare Rates" } ] } ] }, { "description": "SHOULDER & ELBOW JOINT REPLACEMENT - SOI : 4", "code_information": [ { "code": "3224", "type": "APR-DRG" } ], "standard_charges": [ { "setting": "inpatient", "minimum": 46314.88, "maximum": 50946.36, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Better Health - Medi Medi", "methodology": "case rate", "standard_charge_dollar": 50946.36, "additional_payer_notes": "110% of State Medicaid Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Better Health Medicaid", "methodology": "case rate", "standard_charge_dollar": 50946.36, "additional_payer_notes": "110% of State Medicaid Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "case rate", "standard_charge_dollar": 46314.88, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "UBH", "plan_name": "UBH Medicaid", "methodology": "case rate", "standard_charge_dollar": 46314.88, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicaid (02/01/2023 to 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 47241.17, "additional_payer_notes": "102% of State Medicaid Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicaid", "methodology": "case rate", "standard_charge_dollar": 46314.88, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup Medicaid", "methodology": "case rate", "standard_charge_dollar": 46314.88, "additional_payer_notes": "100% of State Medicaid Rates" } ] } ] }, { "description": "MALNUTRITION, FAILURE TO THRIVE & OTHER NUTRITIONAL DISORDERS - SOI : 3", "code_information": [ { "code": "4213", "type": "APR-DRG" } ], "standard_charges": [ { "setting": "inpatient", "minimum": 11633.47, "maximum": 12796.82, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Better Health - Medi Medi", "methodology": "case rate", "standard_charge_dollar": 12796.82, "additional_payer_notes": "110% of State Medicaid Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Better Health Medicaid", "methodology": "case rate", "standard_charge_dollar": 12796.82, "additional_payer_notes": "110% of State Medicaid Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "case rate", "standard_charge_dollar": 11633.47, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "UBH", "plan_name": "UBH Medicaid", "methodology": "case rate", "standard_charge_dollar": 11633.47, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicaid (02/01/2023 to 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 11866.14, "additional_payer_notes": "102% of State Medicaid Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicaid", "methodology": "case rate", "standard_charge_dollar": 11633.47, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup Medicaid", "methodology": "case rate", "standard_charge_dollar": 11633.47, "additional_payer_notes": "100% of State Medicaid Rates" } ] } ] }, { "description": "Sho Arthrs Srg Capsulorraphy", "code_information": [ { "code": "29806", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 44089.5, "discounted_cash": 8578.0, "minimum": 1715.0, "maximum": 35271.6, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 18186.06, "additional_payer_notes": "212.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medical Rental Network", "methodology": "fee schedule", "standard_charge_dollar": 18186.06, "additional_payer_notes": "212.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 8578.33, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "ALLY-ALIGN (FKA SPARTAN PLAN NJ, INC.)", "plan_name": "ALLY-ALIGN (FKA SPARTAN PLAN NJ, INC.)", "methodology": "fee schedule", "standard_charge_dollar": 9007.25, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Americhoice (UHC)", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 8578.33, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Amerihealth", "plan_name": "Amerihealth Medicare", "methodology": "fee schedule", "standard_charge_dollar": 8578.33, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 12605.86, "additional_payer_notes": "146.95% of Medicare Rates" }, { "payer_name": "Clover Health", "plan_name": "Clover Medicare", "methodology": "fee schedule", "standard_charge_dollar": 8578.33, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Coventry", "plan_name": "Coventry Auto", "methodology": "fee schedule", "standard_charge_dollar": 17156.66, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Coventry", "plan_name": "Coventry Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 17156.66, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "fee schedule", "standard_charge_dollar": 12009.66, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Fairprice Healthcare Holdings", "plan_name": "Fairprice Healthcare Holdings", "methodology": "fee schedule", "standard_charge_dollar": 13725.33, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ HMO POS", "methodology": "fee schedule", "standard_charge_dollar": 15209.38, "additional_payer_notes": "177.30% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ Indemnity", "methodology": "fee schedule", "standard_charge_dollar": 15209.38, "additional_payer_notes": "177.30% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ PPO", "methodology": "fee schedule", "standard_charge_dollar": 15209.38, "additional_payer_notes": "177.30% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon Medicare", "methodology": "fee schedule", "standard_charge_dollar": 8578.33, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Military Tricare", "methodology": "fee schedule", "standard_charge_dollar": 6862.66, "additional_payer_notes": "80.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 8578.33, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 8578.33, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC All Payer (02-01-2023 to 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 6624.0 }, { "payer_name": "UHC", "plan_name": "UHC Oxford (02-01-2023 to 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 6317.0 }, { "payer_name": "UHC - Adhoc", "plan_name": "UHC - Adhoc All Payer", "methodology": "case rate", "standard_charge_dollar": 7031.0 }, { "payer_name": "UHC - Adhoc", "plan_name": "UHC - Adhoc Oxford", "methodology": "case rate", "standard_charge_dollar": 6510.0 }, { "payer_name": "Wellcare", "plan_name": "Wellcare Insurance Exchange", "methodology": "fee schedule", "standard_charge_dollar": 11580.75, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 8578.33, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellchoice", "plan_name": "WELLCHOICE HMO of NJ (Empire) Commercial (HMO / HMO POS, PPO)", "methodology": "case rate", "standard_charge_dollar": 1715.0 }, { "payer_name": "Wellchoice", "plan_name": "WELLCHOICE HMO of NJ (Empire) Commercial (Indemnity)", "methodology": "case rate", "standard_charge_dollar": 1978.0 }, { "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup Medicaid", "methodology": "percent of total billed charges", "standard_charge_percentage": 19.09, "median_amount": 6456.63, "10th_percentile": 6456.63, "90th_percentile": 6456.63, "count": "1 through 10" }, { "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup Medicare", "methodology": "fee schedule", "standard_charge_dollar": 8578.33, "additional_payer_notes": "100.00% of Medicare Rates" } ] } ] }, { "description": "Hc Ed Level 3", "code_information": [ { "code": "99283", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 1634.95, "discounted_cash": 322.0, "minimum": 140.0, "maximum": 1331.0, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 684.15, "additional_payer_notes": "212.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medical Rental Network", "methodology": "fee schedule", "standard_charge_dollar": 684.15, "additional_payer_notes": "212.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 322.71, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "ALLY-ALIGN (FKA SPARTAN PLAN NJ, INC.)", "plan_name": "ALLY-ALIGN (FKA SPARTAN PLAN NJ, INC.)", "methodology": "fee schedule", "standard_charge_dollar": 338.85, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Americhoice (UHC)", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 322.71, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Amerihealth", "plan_name": "Amerihealth HMO", "methodology": "case rate", "standard_charge_dollar": 1331.0 }, { "payer_name": "Amerihealth", "plan_name": "Amerihealth Medicare", "methodology": "fee schedule", "standard_charge_dollar": 322.71, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 474.22, "additional_payer_notes": "146.95% of Medicare Rates" }, { "payer_name": "Clover Health", "plan_name": "Clover Medicare", "methodology": "fee schedule", "standard_charge_dollar": 322.71, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Coventry", "plan_name": "Coventry Auto", "methodology": "fee schedule", "standard_charge_dollar": 645.42, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Coventry", "plan_name": "Coventry Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 645.42, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "fee schedule", "standard_charge_dollar": 451.79, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Fairprice Healthcare Holdings", "plan_name": "Fairprice Healthcare Holdings", "methodology": "fee schedule", "standard_charge_dollar": 516.34, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ HMO POS", "methodology": "fee schedule", "standard_charge_dollar": 572.16, "additional_payer_notes": "177.30% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ Indemnity", "methodology": "fee schedule", "standard_charge_dollar": 572.16, "additional_payer_notes": "177.30% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ PPO", "methodology": "fee schedule", "standard_charge_dollar": 572.16, "additional_payer_notes": "177.30% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon Casualty Services Personal Injury Protection - PIP", "methodology": "case rate", "standard_charge_dollar": 764.0 }, { "payer_name": "Horizon", "plan_name": "Horizon Casualty Services Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 764.0 }, { "payer_name": "Horizon", "plan_name": "Horizon Medicare", "methodology": "fee schedule", "standard_charge_dollar": 322.71, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon NJ Health Medicaid", "methodology": "case rate", "standard_charge_dollar": 140.0 }, { "payer_name": "Humana", "plan_name": "Humana Military Tricare", "methodology": "fee schedule", "standard_charge_dollar": 258.17, "additional_payer_notes": "80.00% of Medicare Rates" }, { "payer_name": "Keenan", "plan_name": "Keenan", "methodology": "percent of total billed charges", "standard_charge_percentage": 30.0, "median_amount": 490.49, "10th_percentile": 490.48, "90th_percentile": 490.49, "count": "95" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 322.71, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 322.71, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC All Payer (02-01-2023 to 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 1166.0 }, { "payer_name": "UHC", "plan_name": "UHC Medicaid (02/01/2023 to 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 140.0 }, { "payer_name": "UHC", "plan_name": "UHC Oxford (02-01-2023 to 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 880.0 }, { "payer_name": "UHC - Adhoc", "plan_name": "UHC - Adhoc All Payer", "methodology": "case rate", "standard_charge_dollar": 1238.0 }, { "payer_name": "UHC - Adhoc", "plan_name": "UHC - Adhoc Oxford", "methodology": "case rate", "standard_charge_dollar": 907.0 }, { "payer_name": "Wellcare", "plan_name": "Wellcare Insurance Exchange", "methodology": "fee schedule", "standard_charge_dollar": 435.66, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 322.71, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellchoice", "plan_name": "WELLCHOICE HMO of NJ (Empire) Commercial (HMO / HMO POS, PPO)", "methodology": "fee schedule", "standard_charge_dollar": 337.0 }, { "payer_name": "Wellchoice", "plan_name": "WELLCHOICE HMO of NJ (Empire) Commercial (Indemnity)", "methodology": "fee schedule", "standard_charge_dollar": 369.0 }, { "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup Medicaid", "methodology": "case rate", "standard_charge_dollar": 140.0 }, { "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup Medicare", "methodology": "fee schedule", "standard_charge_dollar": 322.71, "additional_payer_notes": "100.00% of Medicare Rates" } ] } ] }, { "description": "Hip Arthro Acetabuloplasty", "code_information": [ { "code": "29915", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 43821.0, "discounted_cash": 8578.0, "minimum": 1715.0, "maximum": 35056.8, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 18186.06, "additional_payer_notes": "212.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medical Rental Network", "methodology": "fee schedule", "standard_charge_dollar": 18186.06, "additional_payer_notes": "212.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 8578.33, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "ALLY-ALIGN (FKA SPARTAN PLAN NJ, INC.)", "plan_name": "ALLY-ALIGN (FKA SPARTAN PLAN NJ, INC.)", "methodology": "fee schedule", "standard_charge_dollar": 9007.25, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Americhoice (UHC)", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 8578.33, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Amerihealth", "plan_name": "Amerihealth Medicare", "methodology": "fee schedule", "standard_charge_dollar": 8578.33, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 12605.86, "additional_payer_notes": "146.95% of Medicare Rates" }, { "payer_name": "Clover Health", "plan_name": "Clover Medicare", "methodology": "fee schedule", "standard_charge_dollar": 8578.33, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Coventry", "plan_name": "Coventry Auto", "methodology": "fee schedule", "standard_charge_dollar": 17156.66, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Coventry", "plan_name": "Coventry Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 17156.66, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "fee schedule", "standard_charge_dollar": 12009.66, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Fairprice Healthcare Holdings", "plan_name": "Fairprice Healthcare Holdings", "methodology": "fee schedule", "standard_charge_dollar": 13725.33, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ HMO POS", "methodology": "fee schedule", "standard_charge_dollar": 15209.38, "additional_payer_notes": "177.30% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ Indemnity", "methodology": "fee schedule", "standard_charge_dollar": 15209.38, "additional_payer_notes": "177.30% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ PPO", "methodology": "fee schedule", "standard_charge_dollar": 15209.38, "additional_payer_notes": "177.30% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon Medicare", "methodology": "fee schedule", "standard_charge_dollar": 8578.33, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Military Tricare", "methodology": "fee schedule", "standard_charge_dollar": 6862.66, "additional_payer_notes": "80.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 8578.33, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 8578.33, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC All Payer (02-01-2023 to 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 6624.0 }, { "payer_name": "UHC", "plan_name": "UHC Oxford (02-01-2023 to 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 6317.0 }, { "payer_name": "UHC - Adhoc", "plan_name": "UHC - Adhoc All Payer", "methodology": "case rate", "standard_charge_dollar": 7031.0 }, { "payer_name": "UHC - Adhoc", "plan_name": "UHC - Adhoc Oxford", "methodology": "case rate", "standard_charge_dollar": 6510.0 }, { "payer_name": "Wellcare", "plan_name": "Wellcare Insurance Exchange", "methodology": "fee schedule", "standard_charge_dollar": 11580.75, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 8578.33, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellchoice", "plan_name": "WELLCHOICE HMO of NJ (Empire) Commercial (HMO / HMO POS, PPO)", "methodology": "case rate", "standard_charge_dollar": 1715.0 }, { "payer_name": "Wellchoice", "plan_name": "WELLCHOICE HMO of NJ (Empire) Commercial (Indemnity)", "methodology": "case rate", "standard_charge_dollar": 1978.0 }, { "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup Medicare", "methodology": "fee schedule", "standard_charge_dollar": 8578.33, "additional_payer_notes": "100.00% of Medicare Rates" } ] } ] }, { "description": "MUSCULOSKELETAL MALIGNANCY & PATHOL FRACTURE DT MUSCSKEL MALIG - SOI : 3", "code_information": [ { "code": "3433", "type": "APR-DRG" } ], "standard_charges": [ { "setting": "inpatient", "minimum": 16583.4, "maximum": 18241.74, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Better Health - Medi Medi", "methodology": "case rate", "standard_charge_dollar": 18241.74, "additional_payer_notes": "110% of State Medicaid Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Better Health Medicaid", "methodology": "case rate", "standard_charge_dollar": 18241.74, "additional_payer_notes": "110% of State Medicaid Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "case rate", "standard_charge_dollar": 16583.4, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "UBH", "plan_name": "UBH Medicaid", "methodology": "case rate", "standard_charge_dollar": 16583.4, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicaid (02/01/2023 to 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 16915.07, "additional_payer_notes": "102% of State Medicaid Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicaid", "methodology": "case rate", "standard_charge_dollar": 16583.4, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup Medicaid", "methodology": "case rate", "standard_charge_dollar": 16583.4, "additional_payer_notes": "100% of State Medicaid Rates" } ] } ] }, { "description": "Hc Drug Screening Methylenedioxyamphetamines - G0480 - 30180359", "code_information": [ { "code": "G0480", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 292.0, "discounted_cash": 114.0, "minimum": 8.3996, "maximum": 754.8, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 242.59, "additional_payer_notes": "212.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medical Rental Network", "methodology": "fee schedule", "standard_charge_dollar": 242.59, "additional_payer_notes": "212.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 114.43, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "ALLY-ALIGN (FKA SPARTAN PLAN NJ, INC.)", "plan_name": "ALLY-ALIGN (FKA SPARTAN PLAN NJ, INC.)", "methodology": "fee schedule", "standard_charge_dollar": 120.15, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Americhoice (UHC)", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 114.43, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Amerihealth", "plan_name": "Amerihealth Medicare", "methodology": "fee schedule", "standard_charge_dollar": 114.43, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 165.92, "additional_payer_notes": "Laboratory - 145.00% of Medicare Rates" }, { "payer_name": "Clover Health", "plan_name": "Clover Medicare", "methodology": "fee schedule", "standard_charge_dollar": 114.43, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Coventry", "plan_name": "Coventry Auto", "methodology": "fee schedule", "standard_charge_dollar": 228.86, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Coventry", "plan_name": "Coventry Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 228.86, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "fee schedule", "standard_charge_dollar": 160.2, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Fairprice Healthcare Holdings", "plan_name": "Fairprice Healthcare Holdings", "methodology": "fee schedule", "standard_charge_dollar": 137.32, "additional_payer_notes": "Laboratory - 120.00% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ HMO POS", "methodology": "fee schedule", "standard_charge_dollar": 206.15, "additional_payer_notes": "177.30% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ Indemnity", "methodology": "fee schedule", "standard_charge_dollar": 206.15, "additional_payer_notes": "177.30% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ PPO", "methodology": "fee schedule", "standard_charge_dollar": 206.15, "additional_payer_notes": "177.30% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon Medicare", "methodology": "fee schedule", "standard_charge_dollar": 114.43, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Military Tricare", "methodology": "fee schedule", "standard_charge_dollar": 91.54, "additional_payer_notes": "80.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 114.43, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 114.43, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC All Payer (02-01-2023 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 68.66 }, { "payer_name": "UHC", "plan_name": "UHC Medicaid (02/01/2023 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 91.54 }, { "payer_name": "UHC", "plan_name": "UHC Oxford (02-01-2023 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 68.66 }, { "payer_name": "UHC - Adhoc", "plan_name": "UHC - Adhoc All Payer", "methodology": "fee schedule", "standard_charge_dollar": 114.43 }, { "payer_name": "UHC - Adhoc", "plan_name": "UHC - Adhoc Oxford", "methodology": "fee schedule", "standard_charge_dollar": 114.43 }, { "payer_name": "Wellcare", "plan_name": "Wellcare Insurance Exchange", "methodology": "fee schedule", "standard_charge_dollar": 154.48, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 114.43, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup Medicare", "methodology": "fee schedule", "standard_charge_dollar": 114.43, "additional_payer_notes": "100.00% of Medicare Rates" } ] } ] }, { "description": "Revise Ulnar Nerve At Wrist", "code_information": [ { "code": "64719", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 17310.0, "discounted_cash": 2308.0, "minimum": 1715.0, "maximum": 13848.0, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 4894.04, "additional_payer_notes": "212.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medical Rental Network", "methodology": "fee schedule", "standard_charge_dollar": 4894.04, "additional_payer_notes": "212.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2308.51, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "ALLY-ALIGN (FKA SPARTAN PLAN NJ, INC.)", "plan_name": "ALLY-ALIGN (FKA SPARTAN PLAN NJ, INC.)", "methodology": "fee schedule", "standard_charge_dollar": 2423.94, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Americhoice (UHC)", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2308.51, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Amerihealth", "plan_name": "Amerihealth Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2308.51, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 3392.36, "additional_payer_notes": "146.95% of Medicare Rates" }, { "payer_name": "Clover Health", "plan_name": "Clover Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2308.51, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Coventry", "plan_name": "Coventry Auto", "methodology": "fee schedule", "standard_charge_dollar": 4617.02, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Coventry", "plan_name": "Coventry Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 4617.02, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "fee schedule", "standard_charge_dollar": 3231.91, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Fairprice Healthcare Holdings", "plan_name": "Fairprice Healthcare Holdings", "methodology": "fee schedule", "standard_charge_dollar": 3693.62, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ HMO POS", "methodology": "fee schedule", "standard_charge_dollar": 4092.99, "additional_payer_notes": "177.30% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ Indemnity", "methodology": "fee schedule", "standard_charge_dollar": 4092.99, "additional_payer_notes": "177.30% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ PPO", "methodology": "fee schedule", "standard_charge_dollar": 4092.99, "additional_payer_notes": "177.30% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2308.51, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Military Tricare", "methodology": "fee schedule", "standard_charge_dollar": 1846.81, "additional_payer_notes": "80.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2308.51, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 2308.51, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC All Payer (02-01-2023 to 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 4415.0 }, { "payer_name": "UHC", "plan_name": "UHC Oxford (02-01-2023 to 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 4020.0 }, { "payer_name": "UHC - Adhoc", "plan_name": "UHC - Adhoc All Payer", "methodology": "case rate", "standard_charge_dollar": 4687.0 }, { "payer_name": "UHC - Adhoc", "plan_name": "UHC - Adhoc Oxford", "methodology": "case rate", "standard_charge_dollar": 4143.0 }, { "payer_name": "Wellcare", "plan_name": "Wellcare Insurance Exchange", "methodology": "fee schedule", "standard_charge_dollar": 3116.49, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2308.51, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellchoice", "plan_name": "WELLCHOICE HMO of NJ (Empire) Commercial (HMO / HMO POS, PPO)", "methodology": "case rate", "standard_charge_dollar": 1715.0 }, { "payer_name": "Wellchoice", "plan_name": "WELLCHOICE HMO of NJ (Empire) Commercial (Indemnity)", "methodology": "case rate", "standard_charge_dollar": 1978.0 }, { "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2308.51, "additional_payer_notes": "100.00% of Medicare Rates" } ] } ] }, { "description": "Hc Penile Vascular Study,Ltd Or F/U", "code_information": [ { "code": "93981", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 544.85, "discounted_cash": 123.0, "minimum": 98.872, "maximum": 544.85, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 262.01, "additional_payer_notes": "212.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medical Rental Network", "methodology": "fee schedule", "standard_charge_dollar": 262.01, "additional_payer_notes": "212.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 123.59, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "ALLY-ALIGN (FKA SPARTAN PLAN NJ, INC.)", "plan_name": "ALLY-ALIGN (FKA SPARTAN PLAN NJ, INC.)", "methodology": "fee schedule", "standard_charge_dollar": 129.77, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Americhoice (UHC)", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 123.59, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Amerihealth", "plan_name": "Amerihealth Medicare", "methodology": "fee schedule", "standard_charge_dollar": 123.59, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 181.62, "additional_payer_notes": "146.95% of Medicare Rates" }, { "payer_name": "Clover Health", "plan_name": "Clover Medicare", "methodology": "fee schedule", "standard_charge_dollar": 123.59, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Coventry", "plan_name": "Coventry Auto", "methodology": "fee schedule", "standard_charge_dollar": 247.18, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Coventry", "plan_name": "Coventry Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 247.18, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "fee schedule", "standard_charge_dollar": 173.03, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Fairprice Healthcare Holdings", "plan_name": "Fairprice Healthcare Holdings", "methodology": "fee schedule", "standard_charge_dollar": 197.74, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ HMO POS", "methodology": "fee schedule", "standard_charge_dollar": 219.13, "additional_payer_notes": "177.30% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ Indemnity", "methodology": "fee schedule", "standard_charge_dollar": 219.13, "additional_payer_notes": "177.30% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ PPO", "methodology": "fee schedule", "standard_charge_dollar": 219.13, "additional_payer_notes": "177.30% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon Medicare", "methodology": "fee schedule", "standard_charge_dollar": 123.59, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Military Tricare", "methodology": "fee schedule", "standard_charge_dollar": 98.87, "additional_payer_notes": "80.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 123.59, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 123.59, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC All Payer (02-01-2023 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 544.85 }, { "payer_name": "UHC", "plan_name": "UHC Oxford (02-01-2023 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 544.85 }, { "payer_name": "UHC - Adhoc", "plan_name": "UHC - Adhoc All Payer", "methodology": "fee schedule", "standard_charge_dollar": 544.85 }, { "payer_name": "UHC - Adhoc", "plan_name": "UHC - Adhoc Oxford", "methodology": "fee schedule", "standard_charge_dollar": 544.85 }, { "payer_name": "Wellcare", "plan_name": "Wellcare Insurance Exchange", "methodology": "fee schedule", "standard_charge_dollar": 166.85, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 123.59, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup Medicare", "methodology": "fee schedule", "standard_charge_dollar": 123.59, "additional_payer_notes": "100.00% of Medicare Rates" } ] } ] }, { "description": "Hc Rem Pac Cvdfb Plse Gen &Repl Plse Gen Sngl Lead", "code_information": [ { "code": "33262", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 65989.4, "discounted_cash": 26296.0, "minimum": 2472.0, "maximum": 55748.4952, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 55748.5, "additional_payer_notes": "212.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medical Rental Network", "methodology": "fee schedule", "standard_charge_dollar": 55748.5, "additional_payer_notes": "212.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 26296.46, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "ALLY-ALIGN (FKA SPARTAN PLAN NJ, INC.)", "plan_name": "ALLY-ALIGN (FKA SPARTAN PLAN NJ, INC.)", "methodology": "fee schedule", "standard_charge_dollar": 27611.28, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Americhoice (UHC)", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 26296.46, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Amerihealth", "plan_name": "Amerihealth Medicare", "methodology": "fee schedule", "standard_charge_dollar": 26296.46, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 38642.65, "additional_payer_notes": "146.95% of Medicare Rates" }, { "payer_name": "Clover Health", "plan_name": "Clover Medicare", "methodology": "fee schedule", "standard_charge_dollar": 26296.46, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Coventry", "plan_name": "Coventry Auto", "methodology": "fee schedule", "standard_charge_dollar": 52592.92, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Coventry", "plan_name": "Coventry Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 52592.92, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "fee schedule", "standard_charge_dollar": 36815.04, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Fairprice Healthcare Holdings", "plan_name": "Fairprice Healthcare Holdings", "methodology": "fee schedule", "standard_charge_dollar": 42074.34, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ HMO POS", "methodology": "fee schedule", "standard_charge_dollar": 46623.62, "additional_payer_notes": "177.30% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ Indemnity", "methodology": "fee schedule", "standard_charge_dollar": 46623.62, "additional_payer_notes": "177.30% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ PPO", "methodology": "fee schedule", "standard_charge_dollar": 46623.62, "additional_payer_notes": "177.30% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon Medicare", "methodology": "fee schedule", "standard_charge_dollar": 26296.46, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Military Tricare", "methodology": "fee schedule", "standard_charge_dollar": 21037.17, "additional_payer_notes": "80.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 26296.46, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 26296.46, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC All Payer (02-01-2023 to 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 8250.0 }, { "payer_name": "UHC", "plan_name": "UHC Oxford (02-01-2023 to 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 6317.0 }, { "payer_name": "UHC - Adhoc", "plan_name": "UHC - Adhoc All Payer", "methodology": "case rate", "standard_charge_dollar": 8757.0 }, { "payer_name": "UHC - Adhoc", "plan_name": "UHC - Adhoc Oxford", "methodology": "case rate", "standard_charge_dollar": 6510.0 }, { "payer_name": "Wellcare", "plan_name": "Wellcare Insurance Exchange", "methodology": "fee schedule", "standard_charge_dollar": 35500.22, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 26296.46, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellchoice", "plan_name": "WELLCHOICE HMO of NJ (Empire) Commercial (HMO / HMO POS, PPO)", "methodology": "case rate", "standard_charge_dollar": 2472.0 }, { "payer_name": "Wellchoice", "plan_name": "WELLCHOICE HMO of NJ (Empire) Commercial (Indemnity)", "methodology": "case rate", "standard_charge_dollar": 2753.0 }, { "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup Medicare", "methodology": "fee schedule", "standard_charge_dollar": 26296.46, "additional_payer_notes": "100.00% of Medicare Rates" } ] } ] }, { "description": "Removal of ankleheel lesion", "code_information": [ { "code": "28100", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 6025.5, "discounted_cash": 3868.0, "minimum": 1150.2679, "maximum": 6025.5, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 6025.5, "additional_payer_notes": "212.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medical Rental Network", "methodology": "fee schedule", "standard_charge_dollar": 6025.5, "additional_payer_notes": "212.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3868.17, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "ALLY-ALIGN (FKA SPARTAN PLAN NJ, INC.)", "plan_name": "ALLY-ALIGN (FKA SPARTAN PLAN NJ, INC.)", "methodology": "fee schedule", "standard_charge_dollar": 4061.58, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Americhoice (UHC)", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3868.17, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Amerihealth", "plan_name": "Amerihealth Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3868.17, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 5684.28, "additional_payer_notes": "146.95% of Medicare Rates" }, { "payer_name": "Clover Health", "plan_name": "Clover Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3868.17, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Coventry", "plan_name": "Coventry Auto", "methodology": "fee schedule", "standard_charge_dollar": 6025.5, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Coventry", "plan_name": "Coventry Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 6025.5, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "fee schedule", "standard_charge_dollar": 5415.44, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Fairprice Healthcare Holdings", "plan_name": "Fairprice Healthcare Holdings", "methodology": "fee schedule", "standard_charge_dollar": 6025.5, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ HMO POS", "methodology": "fee schedule", "standard_charge_dollar": 6025.5, "additional_payer_notes": "177.30% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ Indemnity", "methodology": "fee schedule", "standard_charge_dollar": 6025.5, "additional_payer_notes": "177.30% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ PPO", "methodology": "fee schedule", "standard_charge_dollar": 6025.5, "additional_payer_notes": "177.30% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3868.17, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Military Tricare", "methodology": "fee schedule", "standard_charge_dollar": 3094.54, "additional_payer_notes": "80.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3868.17, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 3868.17, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC All Payer (02-01-2023 to 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 4415.0 }, { "payer_name": "UHC", "plan_name": "UHC Oxford (02-01-2023 to 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 4020.0 }, { "payer_name": "UHC - Adhoc", "plan_name": "UHC - Adhoc All Payer", "methodology": "case rate", "standard_charge_dollar": 4687.0 }, { "payer_name": "UHC - Adhoc", "plan_name": "UHC - Adhoc Oxford", "methodology": "case rate", "standard_charge_dollar": 4143.0 }, { "payer_name": "Wellcare", "plan_name": "Wellcare Insurance Exchange", "methodology": "fee schedule", "standard_charge_dollar": 5222.03, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3868.17, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellchoice", "plan_name": "WELLCHOICE HMO of NJ (Empire) Commercial (HMO / HMO POS, PPO)", "methodology": "case rate", "standard_charge_dollar": 1715.0 }, { "payer_name": "Wellchoice", "plan_name": "WELLCHOICE HMO of NJ (Empire) Commercial (Indemnity)", "methodology": "case rate", "standard_charge_dollar": 1978.0 }, { "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3868.17, "additional_payer_notes": "100.00% of Medicare Rates" } ] } ] }, { "description": "Knee arthroscopysurgery - 29883 - ", "code_information": [ { "code": "29883", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 12984.0, "discounted_cash": 3868.0, "minimum": 1715.0, "maximum": 10387.2, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 8200.52, "additional_payer_notes": "212.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medical Rental Network", "methodology": "fee schedule", "standard_charge_dollar": 8200.52, "additional_payer_notes": "212.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3868.17, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "ALLY-ALIGN (FKA SPARTAN PLAN NJ, INC.)", "plan_name": "ALLY-ALIGN (FKA SPARTAN PLAN NJ, INC.)", "methodology": "fee schedule", "standard_charge_dollar": 4061.58, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Americhoice (UHC)", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3868.17, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Amerihealth", "plan_name": "Amerihealth Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3868.17, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 5684.28, "additional_payer_notes": "146.95% of Medicare Rates" }, { "payer_name": "Clover Health", "plan_name": "Clover Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3868.17, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Coventry", "plan_name": "Coventry Auto", "methodology": "fee schedule", "standard_charge_dollar": 7736.34, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Coventry", "plan_name": "Coventry Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 7736.34, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "fee schedule", "standard_charge_dollar": 5415.44, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Fairprice Healthcare Holdings", "plan_name": "Fairprice Healthcare Holdings", "methodology": "fee schedule", "standard_charge_dollar": 6189.07, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ HMO POS", "methodology": "fee schedule", "standard_charge_dollar": 6858.27, "additional_payer_notes": "177.30% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ Indemnity", "methodology": "fee schedule", "standard_charge_dollar": 6858.27, "additional_payer_notes": "177.30% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ PPO", "methodology": "fee schedule", "standard_charge_dollar": 6858.27, "additional_payer_notes": "177.30% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3868.17, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Military Tricare", "methodology": "fee schedule", "standard_charge_dollar": 3094.54, "additional_payer_notes": "80.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3868.17, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 3868.17, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC All Payer (02-01-2023 to 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 5378.0 }, { "payer_name": "UHC", "plan_name": "UHC Oxford (02-01-2023 to 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 5169.0 }, { "payer_name": "UHC - Adhoc", "plan_name": "UHC - Adhoc All Payer", "methodology": "case rate", "standard_charge_dollar": 5709.0 }, { "payer_name": "UHC - Adhoc", "plan_name": "UHC - Adhoc Oxford", "methodology": "case rate", "standard_charge_dollar": 5327.0 }, { "payer_name": "Wellcare", "plan_name": "Wellcare Insurance Exchange", "methodology": "fee schedule", "standard_charge_dollar": 5222.03, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3868.17, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellchoice", "plan_name": "WELLCHOICE HMO of NJ (Empire) Commercial (HMO / HMO POS, PPO)", "methodology": "case rate", "standard_charge_dollar": 1715.0 }, { "payer_name": "Wellchoice", "plan_name": "WELLCHOICE HMO of NJ (Empire) Commercial (Indemnity)", "methodology": "case rate", "standard_charge_dollar": 1978.0 }, { "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3868.17, "additional_payer_notes": "100.00% of Medicare Rates" } ] } ] }, { "description": "Hc Rpr Atrial Septal Dfct Secundum W/Byp W/Wo Patch", "code_information": [ { "code": "33641", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 2500.0, "minimum": 477.25, "maximum": 2500.0, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1678.51, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC All Payer (02-01-2023 to 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 2500.0 }, { "payer_name": "UHC", "plan_name": "UHC Oxford (02-01-2023 to 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 2500.0 }, { "payer_name": "UHC - Adhoc", "plan_name": "UHC - Adhoc All Payer", "methodology": "case rate", "standard_charge_dollar": 2500.0 }, { "payer_name": "UHC - Adhoc", "plan_name": "UHC - Adhoc Oxford", "methodology": "case rate", "standard_charge_dollar": 2500.0 }, { "payer_name": "Wellchoice", "plan_name": "WELLCHOICE HMO of NJ (Empire) Commercial (HMO / HMO POS, PPO)", "methodology": "case rate", "standard_charge_dollar": 1715.0 }, { "payer_name": "Wellchoice", "plan_name": "WELLCHOICE HMO of NJ (Empire) Commercial (Indemnity)", "methodology": "case rate", "standard_charge_dollar": 1978.0 } ] } ] }, { "description": "BIOPSYREMOVAL LYMPH NODES", "code_information": [ { "code": "38500", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 10097.5, "discounted_cash": 4628.0, "minimum": 1715.0, "maximum": 9813.1408, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 9813.14, "additional_payer_notes": "212.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medical Rental Network", "methodology": "fee schedule", "standard_charge_dollar": 9813.14, "additional_payer_notes": "212.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 4628.84, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "ALLY-ALIGN (FKA SPARTAN PLAN NJ, INC.)", "plan_name": "ALLY-ALIGN (FKA SPARTAN PLAN NJ, INC.)", "methodology": "fee schedule", "standard_charge_dollar": 4860.28, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Americhoice (UHC)", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 4628.84, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Amerihealth", "plan_name": "Amerihealth Medicare", "methodology": "fee schedule", "standard_charge_dollar": 4628.84, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 6802.08, "additional_payer_notes": "146.95% of Medicare Rates" }, { "payer_name": "Clover Health", "plan_name": "Clover Medicare", "methodology": "fee schedule", "standard_charge_dollar": 4628.84, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Coventry", "plan_name": "Coventry Auto", "methodology": "fee schedule", "standard_charge_dollar": 9257.68, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Coventry", "plan_name": "Coventry Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 9257.68, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "fee schedule", "standard_charge_dollar": 6480.38, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Fairprice Healthcare Holdings", "plan_name": "Fairprice Healthcare Holdings", "methodology": "fee schedule", "standard_charge_dollar": 7406.14, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ HMO POS", "methodology": "fee schedule", "standard_charge_dollar": 8206.93, "additional_payer_notes": "177.30% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ Indemnity", "methodology": "fee schedule", "standard_charge_dollar": 8206.93, "additional_payer_notes": "177.30% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ PPO", "methodology": "fee schedule", "standard_charge_dollar": 8206.93, "additional_payer_notes": "177.30% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon Medicare", "methodology": "fee schedule", "standard_charge_dollar": 4628.84, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Military Tricare", "methodology": "fee schedule", "standard_charge_dollar": 3703.07, "additional_payer_notes": "80.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 4628.84, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 4628.84, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC All Payer (02-01-2023 to 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 4415.0 }, { "payer_name": "UHC", "plan_name": "UHC Oxford (02-01-2023 to 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 4020.0 }, { "payer_name": "UHC - Adhoc", "plan_name": "UHC - Adhoc All Payer", "methodology": "case rate", "standard_charge_dollar": 4687.0 }, { "payer_name": "UHC - Adhoc", "plan_name": "UHC - Adhoc Oxford", "methodology": "case rate", "standard_charge_dollar": 4143.0 }, { "payer_name": "Wellcare", "plan_name": "Wellcare Insurance Exchange", "methodology": "fee schedule", "standard_charge_dollar": 6248.93, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 4628.84, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellchoice", "plan_name": "WELLCHOICE HMO of NJ (Empire) Commercial (HMO / HMO POS, PPO)", "methodology": "case rate", "standard_charge_dollar": 1715.0 }, { "payer_name": "Wellchoice", "plan_name": "WELLCHOICE HMO of NJ (Empire) Commercial (Indemnity)", "methodology": "case rate", "standard_charge_dollar": 1978.0 }, { "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup Medicare", "methodology": "fee schedule", "standard_charge_dollar": 4628.84, "additional_payer_notes": "100.00% of Medicare Rates" } ] } ] }, { "description": "SKIN GRAFT EXCEPT FOR SKIN ULCER OR CELLULITIS WITHOUT CCMCC", "code_information": [ { "code": "578", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 20121.0, "minimum": 9551.96, "maximum": 36419.0643, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "case rate", "standard_charge_dollar": 36419.06, "additional_payer_notes": "181.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medical Rental Network", "methodology": "case rate", "standard_charge_dollar": 36419.06, "additional_payer_notes": "181.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "case rate", "standard_charge_dollar": 16463.4, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "ALLY-ALIGN (FKA SPARTAN PLAN NJ, INC.)", "plan_name": "ALLY-ALIGN (FKA SPARTAN PLAN NJ, INC.)", "methodology": "case rate", "standard_charge_dollar": 21127.08, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Americhoice (UHC)", "plan_name": "UHC Medicare", "methodology": "case rate", "standard_charge_dollar": 16463.4, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Amerihealth", "plan_name": "Amerihealth Medicare", "methodology": "case rate", "standard_charge_dollar": 16463.4, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Commercial", "methodology": "case rate", "standard_charge_dollar": 23501.63 }, { "payer_name": "Clover Health", "plan_name": "Clover Medicare", "methodology": "case rate", "standard_charge_dollar": 16463.4, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Coventry", "plan_name": "Coventry Auto", "methodology": "case rate", "standard_charge_dollar": 34205.75, "additional_payer_notes": "170.00% of Medicare Rates" }, { "payer_name": "Coventry", "plan_name": "Coventry Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 34205.75, "additional_payer_notes": "170.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "case rate", "standard_charge_dollar": 26157.34, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Fairprice Healthcare Holdings", "plan_name": "Fairprice Healthcare Holdings", "methodology": "case rate", "standard_charge_dollar": 32193.65, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon Medicare", "methodology": "case rate", "standard_charge_dollar": 16463.4, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon NJ Health Medicaid", "methodology": "case rate", "standard_charge_dollar": 9551.96 }, { "payer_name": "Humana", "plan_name": "Humana Military Tricare", "methodology": "case rate", "standard_charge_dollar": 16096.82, "additional_payer_notes": "80.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 20121.03, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 33411.3 }, { "payer_name": "UBH", "plan_name": "UBH Medicare", "methodology": "case rate", "standard_charge_dollar": 16463.4, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC All Payer (02-01-2023 to 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 27077.48 }, { "payer_name": "UHC", "plan_name": "UHC Oxford (02-01-2023 to 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 23598.02 }, { "payer_name": "UHC - Adhoc", "plan_name": "UHC - Adhoc All Payer", "methodology": "case rate", "standard_charge_dollar": 28743.32 }, { "payer_name": "UHC - Adhoc", "plan_name": "UHC - Adhoc Oxford", "methodology": "case rate", "standard_charge_dollar": 24317.68 }, { "payer_name": "Wellcare", "plan_name": "Wellcare Insurance Exchange", "methodology": "case rate", "standard_charge_dollar": 27163.39, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "case rate", "standard_charge_dollar": 16463.4, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup Medicare", "methodology": "case rate", "standard_charge_dollar": 16463.4, "additional_payer_notes": "100.00% of Medicare Rates" } ] } ] }, { "description": "FRACTURE, SPRAIN, STRAIN AND DISLOCATION EXCEPT FEMUR, HIP, PELVIS AND THIGH WITH MCC", "code_information": [ { "code": "562", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 18022.0, "minimum": 8792.65, "maximum": 32620.5078, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "case rate", "standard_charge_dollar": 32620.51, "additional_payer_notes": "181.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medical Rental Network", "methodology": "case rate", "standard_charge_dollar": 32620.51, "additional_payer_notes": "181.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "case rate", "standard_charge_dollar": 14778.2, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "ALLY-ALIGN (FKA SPARTAN PLAN NJ, INC.)", "plan_name": "ALLY-ALIGN (FKA SPARTAN PLAN NJ, INC.)", "methodology": "case rate", "standard_charge_dollar": 18923.5, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Americhoice (UHC)", "plan_name": "UHC Medicare", "methodology": "case rate", "standard_charge_dollar": 14778.2, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Amerihealth", "plan_name": "Amerihealth Medicare", "methodology": "case rate", "standard_charge_dollar": 14778.2, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Commercial", "methodology": "case rate", "standard_charge_dollar": 20844.82 }, { "payer_name": "Clover Health", "plan_name": "Clover Medicare", "methodology": "case rate", "standard_charge_dollar": 14778.2, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Coventry", "plan_name": "Coventry Auto", "methodology": "case rate", "standard_charge_dollar": 30638.05, "additional_payer_notes": "170.00% of Medicare Rates" }, { "payer_name": "Coventry", "plan_name": "Coventry Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 30638.05, "additional_payer_notes": "170.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "case rate", "standard_charge_dollar": 23429.09, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Fairprice Healthcare Holdings", "plan_name": "Fairprice Healthcare Holdings", "methodology": "case rate", "standard_charge_dollar": 28835.81, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon Medicare", "methodology": "case rate", "standard_charge_dollar": 14778.2, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon NJ Health Medicaid", "methodology": "case rate", "standard_charge_dollar": 8792.65 }, { "payer_name": "Humana", "plan_name": "Humana Military Tricare", "methodology": "case rate", "standard_charge_dollar": 14417.9, "additional_payer_notes": "80.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 18022.38, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 17056.3 }, { "payer_name": "UBH", "plan_name": "UBH Medicare", "methodology": "case rate", "standard_charge_dollar": 14778.2, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC All Payer (02-01-2023 to 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 24016.43 }, { "payer_name": "UHC", "plan_name": "UHC Oxford (02-01-2023 to 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 20930.31 }, { "payer_name": "UHC - Adhoc", "plan_name": "UHC - Adhoc All Payer", "methodology": "case rate", "standard_charge_dollar": 25493.95 }, { "payer_name": "UHC - Adhoc", "plan_name": "UHC - Adhoc Oxford", "methodology": "case rate", "standard_charge_dollar": 21568.62 }, { "payer_name": "Wellcare", "plan_name": "Wellcare Insurance Exchange", "methodology": "case rate", "standard_charge_dollar": 24330.21, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "case rate", "standard_charge_dollar": 14778.2, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup Medicare", "methodology": "case rate", "standard_charge_dollar": 14778.2, "additional_payer_notes": "100.00% of Medicare Rates" } ] } ] }, { "description": "TENODESIS OF LONG TENDON OF BICEPS", "code_information": [ { "code": "23430", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 25442.72, "discounted_cash": 8578.0, "minimum": 1715.0, "maximum": 20354.176, "payers_information": [ { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "fee schedule", "standard_charge_dollar": 12009.66, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Fairprice Healthcare Holdings", "plan_name": "Fairprice Healthcare Holdings", "methodology": "fee schedule", "standard_charge_dollar": 13725.33, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ HMO POS", "methodology": "fee schedule", "standard_charge_dollar": 15209.38, "additional_payer_notes": "177.30% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ Indemnity", "methodology": "fee schedule", "standard_charge_dollar": 15209.38, "additional_payer_notes": "177.30% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ PPO", "methodology": "fee schedule", "standard_charge_dollar": 15209.38, "additional_payer_notes": "177.30% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon Medicare", "methodology": "fee schedule", "standard_charge_dollar": 8578.33, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Military Tricare", "methodology": "fee schedule", "standard_charge_dollar": 6862.66, "additional_payer_notes": "80.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 8578.33, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 8578.33, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC All Payer (02-01-2023 to 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 5667.0 }, { "payer_name": "UHC", "plan_name": "UHC Oxford (02-01-2023 to 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 5169.0 }, { "payer_name": "UHC - Adhoc", "plan_name": "UHC - Adhoc All Payer", "methodology": "case rate", "standard_charge_dollar": 6016.0 }, { "payer_name": "UHC - Adhoc", "plan_name": "UHC - Adhoc Oxford", "methodology": "case rate", "standard_charge_dollar": 5327.0 }, { "payer_name": "Wellcare", "plan_name": "Wellcare Insurance Exchange", "methodology": "fee schedule", "standard_charge_dollar": 11580.75, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 8578.33, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellchoice", "plan_name": "WELLCHOICE HMO of NJ (Empire) Commercial (HMO / HMO POS, PPO)", "methodology": "case rate", "standard_charge_dollar": 1715.0 }, { "payer_name": "Wellchoice", "plan_name": "WELLCHOICE HMO of NJ (Empire) Commercial (Indemnity)", "methodology": "case rate", "standard_charge_dollar": 1978.0 }, { "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup Medicare", "methodology": "fee schedule", "standard_charge_dollar": 8578.33, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 18186.06, "additional_payer_notes": "212.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medical Rental Network", "methodology": "fee schedule", "standard_charge_dollar": 18186.06, "additional_payer_notes": "212.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 8578.33, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "ALLY-ALIGN (FKA SPARTAN PLAN NJ, INC.)", "plan_name": "ALLY-ALIGN (FKA SPARTAN PLAN NJ, INC.)", "methodology": "fee schedule", "standard_charge_dollar": 9007.25, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Americhoice (UHC)", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 8578.33, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Amerihealth", "plan_name": "Amerihealth Medicare", "methodology": "fee schedule", "standard_charge_dollar": 8578.33, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 12605.86, "additional_payer_notes": "146.95% of Medicare Rates" }, { "payer_name": "Clover Health", "plan_name": "Clover Medicare", "methodology": "fee schedule", "standard_charge_dollar": 8578.33, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Coventry", "plan_name": "Coventry Auto", "methodology": "fee schedule", "standard_charge_dollar": 17156.66, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Coventry", "plan_name": "Coventry Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 17156.66, "additional_payer_notes": "200.00% of Medicare Rates" } ] } ] }, { "description": "Hc Complement/Function Activity", "code_information": [ { "code": "86161", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 42.6, "discounted_cash": 12.0, "minimum": 7.2, "maximum": 36.21, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 25.44, "additional_payer_notes": "212.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medical Rental Network", "methodology": "fee schedule", "standard_charge_dollar": 25.44, "additional_payer_notes": "212.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 12.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "ALLY-ALIGN (FKA SPARTAN PLAN NJ, INC.)", "plan_name": "ALLY-ALIGN (FKA SPARTAN PLAN NJ, INC.)", "methodology": "fee schedule", "standard_charge_dollar": 12.6, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Americhoice (UHC)", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 12.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Amerihealth", "plan_name": "Amerihealth Medicare", "methodology": "fee schedule", "standard_charge_dollar": 12.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 17.4, "additional_payer_notes": "Laboratory - 145.00% of Medicare Rates" }, { "payer_name": "Clover Health", "plan_name": "Clover Medicare", "methodology": "fee schedule", "standard_charge_dollar": 12.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Coventry", "plan_name": "Coventry Auto", "methodology": "fee schedule", "standard_charge_dollar": 24.0, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Coventry", "plan_name": "Coventry Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 24.0, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "fee schedule", "standard_charge_dollar": 16.8, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Fairprice Healthcare Holdings", "plan_name": "Fairprice Healthcare Holdings", "methodology": "fee schedule", "standard_charge_dollar": 14.4, "additional_payer_notes": "Laboratory - 120.00% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ HMO POS", "methodology": "fee schedule", "standard_charge_dollar": 30.08, "additional_payer_notes": "177.30% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ Indemnity", "methodology": "fee schedule", "standard_charge_dollar": 30.08, "additional_payer_notes": "177.30% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ PPO", "methodology": "fee schedule", "standard_charge_dollar": 30.08, "additional_payer_notes": "177.30% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon Medicare", "methodology": "fee schedule", "standard_charge_dollar": 12.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Military Tricare", "methodology": "fee schedule", "standard_charge_dollar": 9.6, "additional_payer_notes": "80.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 12.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 12.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC All Payer (02-01-2023 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 7.2 }, { "payer_name": "UHC", "plan_name": "UHC Medicaid (02/01/2023 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 9.6 }, { "payer_name": "UHC", "plan_name": "UHC Oxford (02-01-2023 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 7.2 }, { "payer_name": "UHC - Adhoc", "plan_name": "UHC - Adhoc All Payer", "methodology": "fee schedule", "standard_charge_dollar": 12.0 }, { "payer_name": "UHC - Adhoc", "plan_name": "UHC - Adhoc Oxford", "methodology": "fee schedule", "standard_charge_dollar": 12.0 }, { "payer_name": "Wellcare", "plan_name": "Wellcare Insurance Exchange", "methodology": "fee schedule", "standard_charge_dollar": 16.2, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 12.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup Medicare", "methodology": "fee schedule", "standard_charge_dollar": 12.0, "additional_payer_notes": "100.00% of Medicare Rates" } ] } ] }, { "description": "Hc Declot Thrombolytic Agent Implant Dev/Cath", "code_information": [ { "code": "36593", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 1390.32, "discounted_cash": 390.0, "minimum": 265.4121, "maximum": 1390.32, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 827.84, "additional_payer_notes": "212.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medical Rental Network", "methodology": "fee schedule", "standard_charge_dollar": 827.84, "additional_payer_notes": "212.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 390.49, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "ALLY-ALIGN (FKA SPARTAN PLAN NJ, INC.)", "plan_name": "ALLY-ALIGN (FKA SPARTAN PLAN NJ, INC.)", "methodology": "fee schedule", "standard_charge_dollar": 410.01, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Americhoice (UHC)", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 390.49, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Amerihealth", "plan_name": "Amerihealth Medicare", "methodology": "fee schedule", "standard_charge_dollar": 390.49, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 573.83, "additional_payer_notes": "146.95% of Medicare Rates" }, { "payer_name": "Clover Health", "plan_name": "Clover Medicare", "methodology": "fee schedule", "standard_charge_dollar": 390.49, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Coventry", "plan_name": "Coventry Auto", "methodology": "fee schedule", "standard_charge_dollar": 780.98, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Coventry", "plan_name": "Coventry Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 780.98, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "fee schedule", "standard_charge_dollar": 546.69, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Fairprice Healthcare Holdings", "plan_name": "Fairprice Healthcare Holdings", "methodology": "fee schedule", "standard_charge_dollar": 624.78, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ HMO POS", "methodology": "fee schedule", "standard_charge_dollar": 692.34, "additional_payer_notes": "177.30% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ Indemnity", "methodology": "fee schedule", "standard_charge_dollar": 692.34, "additional_payer_notes": "177.30% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ PPO", "methodology": "fee schedule", "standard_charge_dollar": 692.34, "additional_payer_notes": "177.30% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon Medicare", "methodology": "fee schedule", "standard_charge_dollar": 390.49, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon NJ Health Medicaid", "methodology": "percent of total billed charges", "standard_charge_percentage": 19.58, "median_amount": 272.22, "10th_percentile": 272.22, "90th_percentile": 272.22, "count": "1 through 10" }, { "payer_name": "Humana", "plan_name": "Humana Military Tricare", "methodology": "fee schedule", "standard_charge_dollar": 312.39, "additional_payer_notes": "80.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 390.49, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 390.49, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC All Payer (02-01-2023 to 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 1390.32 }, { "payer_name": "UHC", "plan_name": "UHC Oxford (02-01-2023 to 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 1390.32 }, { "payer_name": "UHC - Adhoc", "plan_name": "UHC - Adhoc All Payer", "methodology": "case rate", "standard_charge_dollar": 1390.32 }, { "payer_name": "UHC - Adhoc", "plan_name": "UHC - Adhoc Oxford", "methodology": "case rate", "standard_charge_dollar": 1390.32 }, { "payer_name": "Wellcare", "plan_name": "Wellcare Insurance Exchange", "methodology": "fee schedule", "standard_charge_dollar": 527.16, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 390.49, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup Medicare", "methodology": "fee schedule", "standard_charge_dollar": 390.49, "additional_payer_notes": "100.00% of Medicare Rates" } ] } ] }, { "description": "Hc Blood Type Antigen Donor Reagent Serum, Ea Ag", "code_information": [ { "code": "86902", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 154.53, "discounted_cash": 423.0, "minimum": 3.81, "maximum": 154.53, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 154.53, "additional_payer_notes": "212.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medical Rental Network", "methodology": "fee schedule", "standard_charge_dollar": 154.53, "additional_payer_notes": "212.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 154.53, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "ALLY-ALIGN (FKA SPARTAN PLAN NJ, INC.)", "plan_name": "ALLY-ALIGN (FKA SPARTAN PLAN NJ, INC.)", "methodology": "fee schedule", "standard_charge_dollar": 154.53, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Americhoice (UHC)", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 154.53, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Amerihealth", "plan_name": "Amerihealth Medicare", "methodology": "fee schedule", "standard_charge_dollar": 154.53, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 154.53, "additional_payer_notes": "Laboratory - 145.00% of Medicare Rates" }, { "payer_name": "Clover Health", "plan_name": "Clover Medicare", "methodology": "fee schedule", "standard_charge_dollar": 154.53, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Coventry", "plan_name": "Coventry Auto", "methodology": "fee schedule", "standard_charge_dollar": 154.53, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Coventry", "plan_name": "Coventry Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 154.53, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "fee schedule", "standard_charge_dollar": 154.53, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Fairprice Healthcare Holdings", "plan_name": "Fairprice Healthcare Holdings", "methodology": "fee schedule", "standard_charge_dollar": 154.53, "additional_payer_notes": "Laboratory - 120.00% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ HMO POS", "methodology": "fee schedule", "standard_charge_dollar": 154.53, "additional_payer_notes": "177.30% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ Indemnity", "methodology": "fee schedule", "standard_charge_dollar": 154.53, "additional_payer_notes": "177.30% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ PPO", "methodology": "fee schedule", "standard_charge_dollar": 154.53, "additional_payer_notes": "177.30% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon Medicare", "methodology": "fee schedule", "standard_charge_dollar": 154.53, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Military Tricare", "methodology": "fee schedule", "standard_charge_dollar": 154.53, "additional_payer_notes": "80.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 154.53, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 154.53, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC All Payer (02-01-2023 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 3.81 }, { "payer_name": "UHC", "plan_name": "UHC Medicaid (02/01/2023 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 5.08 }, { "payer_name": "UHC", "plan_name": "UHC Oxford (02-01-2023 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 3.81 }, { "payer_name": "UHC - Adhoc", "plan_name": "UHC - Adhoc All Payer", "methodology": "fee schedule", "standard_charge_dollar": 6.35 }, { "payer_name": "UHC - Adhoc", "plan_name": "UHC - Adhoc Oxford", "methodology": "fee schedule", "standard_charge_dollar": 6.35 }, { "payer_name": "Wellcare", "plan_name": "Wellcare Insurance Exchange", "methodology": "fee schedule", "standard_charge_dollar": 154.53, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 154.53, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup Medicare", "methodology": "fee schedule", "standard_charge_dollar": 154.53, "additional_payer_notes": "100.00% of Medicare Rates" } ] } ] }, { "description": "Optx Medial Ankle Fx", "code_information": [ { "code": "27766", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 43275.0, "discounted_cash": 8578.0, "minimum": 1715.0, "maximum": 34620.0, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 18186.06, "additional_payer_notes": "212.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medical Rental Network", "methodology": "fee schedule", "standard_charge_dollar": 18186.06, "additional_payer_notes": "212.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 8578.33, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "ALLY-ALIGN (FKA SPARTAN PLAN NJ, INC.)", "plan_name": "ALLY-ALIGN (FKA SPARTAN PLAN NJ, INC.)", "methodology": "fee schedule", "standard_charge_dollar": 9007.25, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Americhoice (UHC)", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 8578.33, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Amerihealth", "plan_name": "Amerihealth Medicare", "methodology": "fee schedule", "standard_charge_dollar": 8578.33, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 12605.86, "additional_payer_notes": "146.95% of Medicare Rates" }, { "payer_name": "Clover Health", "plan_name": "Clover Medicare", "methodology": "fee schedule", "standard_charge_dollar": 8578.33, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Coventry", "plan_name": "Coventry Auto", "methodology": "fee schedule", "standard_charge_dollar": 17156.66, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Coventry", "plan_name": "Coventry Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 17156.66, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "fee schedule", "standard_charge_dollar": 12009.66, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Fairprice Healthcare Holdings", "plan_name": "Fairprice Healthcare Holdings", "methodology": "fee schedule", "standard_charge_dollar": 13725.33, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ HMO POS", "methodology": "fee schedule", "standard_charge_dollar": 15209.38, "additional_payer_notes": "177.30% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ Indemnity", "methodology": "fee schedule", "standard_charge_dollar": 15209.38, "additional_payer_notes": "177.30% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ PPO", "methodology": "fee schedule", "standard_charge_dollar": 15209.38, "additional_payer_notes": "177.30% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon Medicare", "methodology": "fee schedule", "standard_charge_dollar": 8578.33, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Military Tricare", "methodology": "fee schedule", "standard_charge_dollar": 6862.66, "additional_payer_notes": "80.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 8578.33, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 8578.33, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC All Payer (02-01-2023 to 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 6624.0 }, { "payer_name": "UHC", "plan_name": "UHC Oxford (02-01-2023 to 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 6317.0 }, { "payer_name": "UHC - Adhoc", "plan_name": "UHC - Adhoc All Payer", "methodology": "case rate", "standard_charge_dollar": 7031.0 }, { "payer_name": "UHC - Adhoc", "plan_name": "UHC - Adhoc Oxford", "methodology": "case rate", "standard_charge_dollar": 6510.0 }, { "payer_name": "Wellcare", "plan_name": "Wellcare Insurance Exchange", "methodology": "fee schedule", "standard_charge_dollar": 11580.75, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 8578.33, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellchoice", "plan_name": "WELLCHOICE HMO of NJ (Empire) Commercial (HMO / HMO POS, PPO)", "methodology": "case rate", "standard_charge_dollar": 1715.0 }, { "payer_name": "Wellchoice", "plan_name": "WELLCHOICE HMO of NJ (Empire) Commercial (Indemnity)", "methodology": "case rate", "standard_charge_dollar": 1978.0 }, { "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup Medicare", "methodology": "fee schedule", "standard_charge_dollar": 8578.33, "additional_payer_notes": "100.00% of Medicare Rates" } ] } ] }, { "description": "Hc Angio Retro Brachial Angio", "code_information": [ { "code": "75710", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 14308.3, "discounted_cash": 3732.0, "minimum": 706.9027, "maximum": 12162.055, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 7913.51, "additional_payer_notes": "212.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medical Rental Network", "methodology": "fee schedule", "standard_charge_dollar": 7913.51, "additional_payer_notes": "212.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3732.79, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "ALLY-ALIGN (FKA SPARTAN PLAN NJ, INC.)", "plan_name": "ALLY-ALIGN (FKA SPARTAN PLAN NJ, INC.)", "methodology": "fee schedule", "standard_charge_dollar": 3919.43, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Americhoice (UHC)", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3732.79, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Amerihealth", "plan_name": "Amerihealth Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3732.79, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 5485.33, "additional_payer_notes": "146.95% of Medicare Rates" }, { "payer_name": "Clover Health", "plan_name": "Clover Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3732.79, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Coventry", "plan_name": "Coventry Auto", "methodology": "fee schedule", "standard_charge_dollar": 7465.58, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Coventry", "plan_name": "Coventry Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 7465.58, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "fee schedule", "standard_charge_dollar": 5225.91, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Fairprice Healthcare Holdings", "plan_name": "Fairprice Healthcare Holdings", "methodology": "fee schedule", "standard_charge_dollar": 5972.46, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ HMO POS", "methodology": "fee schedule", "standard_charge_dollar": 6618.24, "additional_payer_notes": "177.30% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ Indemnity", "methodology": "fee schedule", "standard_charge_dollar": 6618.24, "additional_payer_notes": "177.30% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ PPO", "methodology": "fee schedule", "standard_charge_dollar": 6618.24, "additional_payer_notes": "177.30% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3732.79, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Military Tricare", "methodology": "fee schedule", "standard_charge_dollar": 2986.23, "additional_payer_notes": "80.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3732.79, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 3732.79, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC All Payer (02-01-2023 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 4292.49 }, { "payer_name": "UHC", "plan_name": "UHC Medicaid (02/01/2023 to 12-31-2026)", "methodology": "percent of total billed charges", "standard_charge_percentage": 19.47, "median_amount": 3706.68, "10th_percentile": 3706.68, "90th_percentile": 3706.68, "count": "1 through 10" }, { "payer_name": "UHC", "plan_name": "UHC Oxford (02-01-2023 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 4292.49 }, { "payer_name": "UHC - Adhoc", "plan_name": "UHC - Adhoc All Payer", "methodology": "fee schedule", "standard_charge_dollar": 2861.66 }, { "payer_name": "UHC - Adhoc", "plan_name": "UHC - Adhoc Oxford", "methodology": "fee schedule", "standard_charge_dollar": 2861.66 }, { "payer_name": "Wellcare", "plan_name": "Wellcare Insurance Exchange", "methodology": "fee schedule", "standard_charge_dollar": 5039.27, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3732.79, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup Medicaid", "methodology": "percent of total billed charges", "standard_charge_percentage": 19.09, "median_amount": 3706.68, "10th_percentile": 3706.68, "90th_percentile": 3706.68, "count": "1 through 10" }, { "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3732.79, "additional_payer_notes": "100.00% of Medicare Rates" } ] } ] }, { "description": "ADJUSTMENT DISORDERS & NEUROSES EXCEPT DEPRESSIVE DIAGNOSES - SOI : 1", "code_information": [ { "code": "7551", "type": "APR-DRG" } ], "standard_charges": [ { "setting": "inpatient", "minimum": 3677.6, "maximum": 4045.36, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Better Health - Medi Medi", "methodology": "case rate", "standard_charge_dollar": 4045.36, "additional_payer_notes": "110% of State Medicaid Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Better Health Medicaid", "methodology": "case rate", "standard_charge_dollar": 4045.36, "additional_payer_notes": "110% of State Medicaid Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "case rate", "standard_charge_dollar": 3677.6, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "UBH", "plan_name": "UBH Medicaid", "methodology": "case rate", "standard_charge_dollar": 3677.6, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicaid (02/01/2023 to 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 3751.15, "additional_payer_notes": "102% of State Medicaid Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicaid", "methodology": "case rate", "standard_charge_dollar": 3677.6, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup Medicaid", "methodology": "case rate", "standard_charge_dollar": 3677.6, "additional_payer_notes": "100% of State Medicaid Rates" } ] } ] }, { "description": "Hc Repr Wnd Smp Body/Scalp/Extr <2.5 Cm", "code_information": [ { "code": "12001", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 821.86, "discounted_cash": 237.0, "minimum": 156.8931, "maximum": 821.86, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 237.18, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "ALLY-ALIGN (FKA SPARTAN PLAN NJ, INC.)", "plan_name": "ALLY-ALIGN (FKA SPARTAN PLAN NJ, INC.)", "methodology": "fee schedule", "standard_charge_dollar": 249.04, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Americhoice (UHC)", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 237.18, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Amerihealth", "plan_name": "Amerihealth Medicare", "methodology": "fee schedule", "standard_charge_dollar": 237.18, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 348.54, "additional_payer_notes": "146.95% of Medicare Rates" }, { "payer_name": "Clover Health", "plan_name": "Clover Medicare", "methodology": "fee schedule", "standard_charge_dollar": 237.18, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Coventry", "plan_name": "Coventry Auto", "methodology": "fee schedule", "standard_charge_dollar": 474.36, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Coventry", "plan_name": "Coventry Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 474.36, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "fee schedule", "standard_charge_dollar": 332.05, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Fairprice Healthcare Holdings", "plan_name": "Fairprice Healthcare Holdings", "methodology": "fee schedule", "standard_charge_dollar": 379.49, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ HMO POS", "methodology": "fee schedule", "standard_charge_dollar": 420.52, "additional_payer_notes": "177.30% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ Indemnity", "methodology": "fee schedule", "standard_charge_dollar": 420.52, "additional_payer_notes": "177.30% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ PPO", "methodology": "fee schedule", "standard_charge_dollar": 420.52, "additional_payer_notes": "177.30% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon Medicare", "methodology": "fee schedule", "standard_charge_dollar": 237.18, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Military Tricare", "methodology": "fee schedule", "standard_charge_dollar": 189.74, "additional_payer_notes": "80.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 237.18, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 237.18, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC All Payer (02-01-2023 to 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 821.86 }, { "payer_name": "UHC", "plan_name": "UHC Oxford (02-01-2023 to 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 821.86 }, { "payer_name": "UHC - Adhoc", "plan_name": "UHC - Adhoc All Payer", "methodology": "case rate", "standard_charge_dollar": 821.86 }, { "payer_name": "UHC - Adhoc", "plan_name": "UHC - Adhoc Oxford", "methodology": "case rate", "standard_charge_dollar": 821.86 }, { "payer_name": "Wellcare", "plan_name": "Wellcare Insurance Exchange", "methodology": "fee schedule", "standard_charge_dollar": 320.19, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 237.18, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellchoice", "plan_name": "WELLCHOICE HMO of NJ (Empire) Commercial (HMO / HMO POS, PPO)", "methodology": "case rate", "standard_charge_dollar": 821.86 }, { "payer_name": "Wellchoice", "plan_name": "WELLCHOICE HMO of NJ (Empire) Commercial (Indemnity)", "methodology": "case rate", "standard_charge_dollar": 821.86 }, { "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup Medicare", "methodology": "fee schedule", "standard_charge_dollar": 237.18, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 502.82, "additional_payer_notes": "212.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medical Rental Network", "methodology": "fee schedule", "standard_charge_dollar": 502.82, "additional_payer_notes": "212.00% of Medicare Rates" } ] } ] }, { "description": "DIABETES - SOI : 4", "code_information": [ { "code": "4204", "type": "APR-DRG" } ], "standard_charges": [ { "setting": "inpatient", "minimum": 21406.9, "maximum": 23547.59, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Better Health - Medi Medi", "methodology": "case rate", "standard_charge_dollar": 23547.59, "additional_payer_notes": "110% of State Medicaid Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Better Health Medicaid", "methodology": "case rate", "standard_charge_dollar": 23547.59, "additional_payer_notes": "110% of State Medicaid Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "case rate", "standard_charge_dollar": 21406.9, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "UBH", "plan_name": "UBH Medicaid", "methodology": "case rate", "standard_charge_dollar": 21406.9, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicaid (02/01/2023 to 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 21835.04, "additional_payer_notes": "102% of State Medicaid Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicaid", "methodology": "case rate", "standard_charge_dollar": 21406.9, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup Medicaid", "methodology": "case rate", "standard_charge_dollar": 21406.9, "additional_payer_notes": "100% of State Medicaid Rates" } ] } ] }, { "description": "OTHER INFECTIOUS & PARASITIC DISEASES - SOI : 3", "code_information": [ { "code": "7243", "type": "APR-DRG" } ], "standard_charges": [ { "setting": "inpatient", "minimum": 14096.81, "maximum": 15506.49, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Better Health - Medi Medi", "methodology": "case rate", "standard_charge_dollar": 15506.49, "additional_payer_notes": "110% of State Medicaid Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Better Health Medicaid", "methodology": "case rate", "standard_charge_dollar": 15506.49, "additional_payer_notes": "110% of State Medicaid Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "case rate", "standard_charge_dollar": 14096.81, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "UBH", "plan_name": "UBH Medicaid", "methodology": "case rate", "standard_charge_dollar": 14096.81, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicaid (02/01/2023 to 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 14378.75, "additional_payer_notes": "102% of State Medicaid Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicaid", "methodology": "case rate", "standard_charge_dollar": 14096.81, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup Medicaid", "methodology": "case rate", "standard_charge_dollar": 14096.81, "additional_payer_notes": "100% of State Medicaid Rates" } ] } ] }, { "description": "Repair Eardrum Structures", "code_information": [ { "code": "69631", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 42322.5, "discounted_cash": 6998.0, "minimum": 1715.0, "maximum": 33858.0, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 14836.71, "additional_payer_notes": "212.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medical Rental Network", "methodology": "fee schedule", "standard_charge_dollar": 14836.71, "additional_payer_notes": "212.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 6998.45, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "ALLY-ALIGN (FKA SPARTAN PLAN NJ, INC.)", "plan_name": "ALLY-ALIGN (FKA SPARTAN PLAN NJ, INC.)", "methodology": "fee schedule", "standard_charge_dollar": 7348.37, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Americhoice (UHC)", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 6998.45, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Amerihealth", "plan_name": "Amerihealth Medicare", "methodology": "fee schedule", "standard_charge_dollar": 6998.45, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 10284.22, "additional_payer_notes": "146.95% of Medicare Rates" }, { "payer_name": "Clover Health", "plan_name": "Clover Medicare", "methodology": "fee schedule", "standard_charge_dollar": 6998.45, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Coventry", "plan_name": "Coventry Auto", "methodology": "fee schedule", "standard_charge_dollar": 13996.9, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Coventry", "plan_name": "Coventry Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 13996.9, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "fee schedule", "standard_charge_dollar": 9797.83, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Fairprice Healthcare Holdings", "plan_name": "Fairprice Healthcare Holdings", "methodology": "fee schedule", "standard_charge_dollar": 11197.52, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ HMO POS", "methodology": "fee schedule", "standard_charge_dollar": 12408.25, "additional_payer_notes": "177.30% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ Indemnity", "methodology": "fee schedule", "standard_charge_dollar": 12408.25, "additional_payer_notes": "177.30% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ PPO", "methodology": "fee schedule", "standard_charge_dollar": 12408.25, "additional_payer_notes": "177.30% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon Medicare", "methodology": "fee schedule", "standard_charge_dollar": 6998.45, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Military Tricare", "methodology": "fee schedule", "standard_charge_dollar": 5598.76, "additional_payer_notes": "80.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 6998.45, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 6998.45, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC All Payer (02-01-2023 to 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 5667.0 }, { "payer_name": "UHC", "plan_name": "UHC Oxford (02-01-2023 to 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 5169.0 }, { "payer_name": "UHC - Adhoc", "plan_name": "UHC - Adhoc All Payer", "methodology": "case rate", "standard_charge_dollar": 6016.0 }, { "payer_name": "UHC - Adhoc", "plan_name": "UHC - Adhoc Oxford", "methodology": "case rate", "standard_charge_dollar": 5327.0 }, { "payer_name": "Wellcare", "plan_name": "Wellcare Insurance Exchange", "methodology": "fee schedule", "standard_charge_dollar": 9447.91, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 6998.45, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellchoice", "plan_name": "WELLCHOICE HMO of NJ (Empire) Commercial (HMO / HMO POS, PPO)", "methodology": "case rate", "standard_charge_dollar": 1715.0 }, { "payer_name": "Wellchoice", "plan_name": "WELLCHOICE HMO of NJ (Empire) Commercial (Indemnity)", "methodology": "case rate", "standard_charge_dollar": 1978.0 }, { "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup Medicare", "methodology": "fee schedule", "standard_charge_dollar": 6998.45, "additional_payer_notes": "100.00% of Medicare Rates" } ] } ] }, { "description": "Hc Lyme Disease Antibody, Confirmatory", "code_information": [ { "code": "86617", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 196.38, "discounted_cash": 15.0, "minimum": 9.29, "maximum": 166.923, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 32.84, "additional_payer_notes": "212.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medical Rental Network", "methodology": "fee schedule", "standard_charge_dollar": 32.84, "additional_payer_notes": "212.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 15.49, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "ALLY-ALIGN (FKA SPARTAN PLAN NJ, INC.)", "plan_name": "ALLY-ALIGN (FKA SPARTAN PLAN NJ, INC.)", "methodology": "fee schedule", "standard_charge_dollar": 16.26, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Americhoice (UHC)", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 15.49, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Amerihealth", "plan_name": "Amerihealth Medicare", "methodology": "fee schedule", "standard_charge_dollar": 15.49, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 22.46, "additional_payer_notes": "Laboratory - 145.00% of Medicare Rates" }, { "payer_name": "Clover Health", "plan_name": "Clover Medicare", "methodology": "fee schedule", "standard_charge_dollar": 15.49, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Coventry", "plan_name": "Coventry Auto", "methodology": "fee schedule", "standard_charge_dollar": 30.98, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Coventry", "plan_name": "Coventry Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 30.98, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "fee schedule", "standard_charge_dollar": 21.69, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Fairprice Healthcare Holdings", "plan_name": "Fairprice Healthcare Holdings", "methodology": "fee schedule", "standard_charge_dollar": 18.59, "additional_payer_notes": "Laboratory - 120.00% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ HMO POS", "methodology": "fee schedule", "standard_charge_dollar": 138.64, "additional_payer_notes": "177.30% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ Indemnity", "methodology": "fee schedule", "standard_charge_dollar": 138.64, "additional_payer_notes": "177.30% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ PPO", "methodology": "fee schedule", "standard_charge_dollar": 138.64, "additional_payer_notes": "177.30% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon Medicare", "methodology": "fee schedule", "standard_charge_dollar": 15.49, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Military Tricare", "methodology": "fee schedule", "standard_charge_dollar": 12.39, "additional_payer_notes": "80.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 15.49, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 15.49, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC All Payer (02-01-2023 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 9.29 }, { "payer_name": "UHC", "plan_name": "UHC Medicaid (02/01/2023 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 12.39 }, { "payer_name": "UHC", "plan_name": "UHC Oxford (02-01-2023 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 9.29 }, { "payer_name": "UHC - Adhoc", "plan_name": "UHC - Adhoc All Payer", "methodology": "fee schedule", "standard_charge_dollar": 15.49 }, { "payer_name": "UHC - Adhoc", "plan_name": "UHC - Adhoc Oxford", "methodology": "fee schedule", "standard_charge_dollar": 15.49 }, { "payer_name": "Wellcare", "plan_name": "Wellcare Insurance Exchange", "methodology": "fee schedule", "standard_charge_dollar": 20.91, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 15.49, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup Medicare", "methodology": "fee schedule", "standard_charge_dollar": 15.49, "additional_payer_notes": "100.00% of Medicare Rates" } ] } ] }, { "description": "OTHER MUSCULOSKELETAL SYSTEM & CONNECTIVE TISSUE DIAGNOSES - SOI : 1", "code_information": [ { "code": "3511", "type": "APR-DRG" } ], "standard_charges": [ { "setting": "inpatient", "minimum": 6091.96, "maximum": 6701.15, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Better Health - Medi Medi", "methodology": "case rate", "standard_charge_dollar": 6701.15, "additional_payer_notes": "110% of State Medicaid Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Better Health Medicaid", "methodology": "case rate", "standard_charge_dollar": 6701.15, "additional_payer_notes": "110% of State Medicaid Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "case rate", "standard_charge_dollar": 6091.96, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "UBH", "plan_name": "UBH Medicaid", "methodology": "case rate", "standard_charge_dollar": 6091.96, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicaid (02/01/2023 to 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 6213.8, "additional_payer_notes": "102% of State Medicaid Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicaid", "methodology": "case rate", "standard_charge_dollar": 6091.96, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup Medicaid", "methodology": "case rate", "standard_charge_dollar": 6091.96, "additional_payer_notes": "100% of State Medicaid Rates" } ] } ] }, { "description": "Hc Colonoscopy Thru Stoma Bleed Control", "code_information": [ { "code": "44391", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 5621.8, "discounted_cash": 1414.0, "minimum": 1073.2016, "maximum": 4778.53, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 2999.1, "additional_payer_notes": "212.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medical Rental Network", "methodology": "fee schedule", "standard_charge_dollar": 2999.1, "additional_payer_notes": "212.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1414.67, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "ALLY-ALIGN (FKA SPARTAN PLAN NJ, INC.)", "plan_name": "ALLY-ALIGN (FKA SPARTAN PLAN NJ, INC.)", "methodology": "fee schedule", "standard_charge_dollar": 1485.4, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Americhoice (UHC)", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1414.67, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Amerihealth", "plan_name": "Amerihealth Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1414.67, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 2078.86, "additional_payer_notes": "146.95% of Medicare Rates" }, { "payer_name": "Clover Health", "plan_name": "Clover Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1414.67, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Coventry", "plan_name": "Coventry Auto", "methodology": "fee schedule", "standard_charge_dollar": 2829.34, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Coventry", "plan_name": "Coventry Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 2829.34, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "fee schedule", "standard_charge_dollar": 1980.54, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Fairprice Healthcare Holdings", "plan_name": "Fairprice Healthcare Holdings", "methodology": "fee schedule", "standard_charge_dollar": 2263.47, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ HMO POS", "methodology": "fee schedule", "standard_charge_dollar": 2508.21, "additional_payer_notes": "177.30% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ Indemnity", "methodology": "fee schedule", "standard_charge_dollar": 2508.21, "additional_payer_notes": "177.30% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ PPO", "methodology": "fee schedule", "standard_charge_dollar": 2508.21, "additional_payer_notes": "177.30% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1414.67, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Military Tricare", "methodology": "fee schedule", "standard_charge_dollar": 1131.74, "additional_payer_notes": "80.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1414.67, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 1414.67, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC All Payer (02-01-2023 to 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 3912.0 }, { "payer_name": "UHC", "plan_name": "UHC Oxford (02-01-2023 to 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 3676.0 }, { "payer_name": "UHC - Adhoc", "plan_name": "UHC - Adhoc All Payer", "methodology": "case rate", "standard_charge_dollar": 4153.0 }, { "payer_name": "UHC - Adhoc", "plan_name": "UHC - Adhoc Oxford", "methodology": "case rate", "standard_charge_dollar": 3788.0 }, { "payer_name": "Wellcare", "plan_name": "Wellcare Insurance Exchange", "methodology": "fee schedule", "standard_charge_dollar": 1909.8, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1414.67, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1414.67, "additional_payer_notes": "100.00% of Medicare Rates" } ] } ] }, { "description": "Hc Er / Unscheduled Dialysis For Esrd", "code_information": [ { "code": "G0257", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 3152.6, "discounted_cash": 811.0, "minimum": 601.8313, "maximum": 2679.71, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 1720.08, "additional_payer_notes": "212.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medical Rental Network", "methodology": "fee schedule", "standard_charge_dollar": 1720.08, "additional_payer_notes": "212.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 811.36, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "ALLY-ALIGN (FKA SPARTAN PLAN NJ, INC.)", "plan_name": "ALLY-ALIGN (FKA SPARTAN PLAN NJ, INC.)", "methodology": "fee schedule", "standard_charge_dollar": 851.93, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Americhoice (UHC)", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 811.36, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Amerihealth", "plan_name": "Amerihealth Medicare", "methodology": "fee schedule", "standard_charge_dollar": 811.36, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 1192.29, "additional_payer_notes": "146.95% of Medicare Rates" }, { "payer_name": "Clover Health", "plan_name": "Clover Medicare", "methodology": "fee schedule", "standard_charge_dollar": 811.36, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Coventry", "plan_name": "Coventry Auto", "methodology": "fee schedule", "standard_charge_dollar": 1622.72, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Coventry", "plan_name": "Coventry Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 1622.72, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "fee schedule", "standard_charge_dollar": 1135.9, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Fairprice Healthcare Holdings", "plan_name": "Fairprice Healthcare Holdings", "methodology": "fee schedule", "standard_charge_dollar": 1298.18, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ HMO POS", "methodology": "fee schedule", "standard_charge_dollar": 1438.54, "additional_payer_notes": "177.30% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ Indemnity", "methodology": "fee schedule", "standard_charge_dollar": 1438.54, "additional_payer_notes": "177.30% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ PPO", "methodology": "fee schedule", "standard_charge_dollar": 1438.54, "additional_payer_notes": "177.30% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon Medicare", "methodology": "fee schedule", "standard_charge_dollar": 811.36, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Military Tricare", "methodology": "fee schedule", "standard_charge_dollar": 649.09, "additional_payer_notes": "80.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 811.36, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 811.36, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Insurance Exchange", "methodology": "fee schedule", "standard_charge_dollar": 1095.34, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 811.36, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup Medicare", "methodology": "fee schedule", "standard_charge_dollar": 811.36, "additional_payer_notes": "100.00% of Medicare Rates" } ] } ] }, { "description": "DIGESTIVE MALIGNANCY - SOI : 1", "code_information": [ { "code": "2401", "type": "APR-DRG" } ], "standard_charges": [ { "setting": "inpatient", "minimum": 8862.12, "maximum": 9748.33, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Better Health - Medi Medi", "methodology": "case rate", "standard_charge_dollar": 9748.33, "additional_payer_notes": "110% of State Medicaid Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Better Health Medicaid", "methodology": "case rate", "standard_charge_dollar": 9748.33, "additional_payer_notes": "110% of State Medicaid Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "case rate", "standard_charge_dollar": 8862.12, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "UBH", "plan_name": "UBH Medicaid", "methodology": "case rate", "standard_charge_dollar": 8862.12, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicaid (02/01/2023 to 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 9039.36, "additional_payer_notes": "102% of State Medicaid Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicaid", "methodology": "case rate", "standard_charge_dollar": 8862.12, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup Medicaid", "methodology": "case rate", "standard_charge_dollar": 8862.12, "additional_payer_notes": "100% of State Medicaid Rates" } ] } ] }, { "description": "NON-EXTENSIVE OR PROCEDURES FOR OTHER COMPLICATIONS OF TREATMENT - SOI : 1", "code_information": [ { "code": "7941", "type": "APR-DRG" } ], "standard_charges": [ { "setting": "inpatient", "minimum": 10598.42, "maximum": 11658.26, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Better Health - Medi Medi", "methodology": "case rate", "standard_charge_dollar": 11658.26, "additional_payer_notes": "110% of State Medicaid Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Better Health Medicaid", "methodology": "case rate", "standard_charge_dollar": 11658.26, "additional_payer_notes": "110% of State Medicaid Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "case rate", "standard_charge_dollar": 10598.42, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "UBH", "plan_name": "UBH Medicaid", "methodology": "case rate", "standard_charge_dollar": 10598.42, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicaid (02/01/2023 to 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 10810.38, "additional_payer_notes": "102% of State Medicaid Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicaid", "methodology": "case rate", "standard_charge_dollar": 10598.42, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup Medicaid", "methodology": "case rate", "standard_charge_dollar": 10598.42, "additional_payer_notes": "100% of State Medicaid Rates" } ] } ] }, { "description": "HEART FAILURE AND SHOCK WITH CC", "code_information": [ { "code": "292", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 11368.0, "minimum": 5743.54, "maximum": 20576.3696, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "case rate", "standard_charge_dollar": 20576.37, "additional_payer_notes": "181.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medical Rental Network", "methodology": "case rate", "standard_charge_dollar": 20576.37, "additional_payer_notes": "181.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "case rate", "standard_charge_dollar": 9435.04, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "ALLY-ALIGN (FKA SPARTAN PLAN NJ, INC.)", "plan_name": "ALLY-ALIGN (FKA SPARTAN PLAN NJ, INC.)", "methodology": "case rate", "standard_charge_dollar": 11936.57, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Americhoice (UHC)", "plan_name": "UHC Medicare", "methodology": "case rate", "standard_charge_dollar": 9435.04, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Amerihealth", "plan_name": "Amerihealth Medicare", "methodology": "case rate", "standard_charge_dollar": 9435.04, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Commercial", "methodology": "case rate", "standard_charge_dollar": 12420.87 }, { "payer_name": "Clover Health", "plan_name": "Clover Medicare", "methodology": "case rate", "standard_charge_dollar": 9435.04, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Coventry", "plan_name": "Coventry Auto", "methodology": "case rate", "standard_charge_dollar": 19325.87, "additional_payer_notes": "170.00% of Medicare Rates" }, { "payer_name": "Coventry", "plan_name": "Coventry Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 19325.87, "additional_payer_notes": "170.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "case rate", "standard_charge_dollar": 14778.61, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Fairprice Healthcare Holdings", "plan_name": "Fairprice Healthcare Holdings", "methodology": "case rate", "standard_charge_dollar": 18189.06, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon Medicare", "methodology": "case rate", "standard_charge_dollar": 9435.04, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon NJ Health Medicaid", "methodology": "case rate", "standard_charge_dollar": 5743.54 }, { "payer_name": "Humana", "plan_name": "Humana Military Tricare", "methodology": "case rate", "standard_charge_dollar": 9094.53, "additional_payer_notes": "80.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 11368.16, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 10973.3 }, { "payer_name": "UBH", "plan_name": "UBH Medicare", "methodology": "case rate", "standard_charge_dollar": 9435.04, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC All Payer (02-01-2023 to 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 14310.74 }, { "payer_name": "UHC", "plan_name": "UHC Oxford (02-01-2023 to 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 12471.81 }, { "payer_name": "UHC - Adhoc", "plan_name": "UHC - Adhoc All Payer", "methodology": "case rate", "standard_charge_dollar": 15191.16 }, { "payer_name": "UHC - Adhoc", "plan_name": "UHC - Adhoc Oxford", "methodology": "case rate", "standard_charge_dollar": 12852.16 }, { "payer_name": "Wellcare", "plan_name": "Wellcare Insurance Exchange", "methodology": "case rate", "standard_charge_dollar": 15347.02, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "case rate", "standard_charge_dollar": 9435.04, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup Medicare", "methodology": "case rate", "standard_charge_dollar": 9435.04, "additional_payer_notes": "100.00% of Medicare Rates" } ] } ] }, { "description": "Hc Repr Wnd Intrmd Face 7.6-12.5 Cm", "code_information": [ { "code": "12054", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 1636.94, "discounted_cash": 480.0, "minimum": 312.4918, "maximum": 1636.94, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 1018.83, "additional_payer_notes": "212.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medical Rental Network", "methodology": "fee schedule", "standard_charge_dollar": 1018.83, "additional_payer_notes": "212.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 480.58, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "ALLY-ALIGN (FKA SPARTAN PLAN NJ, INC.)", "plan_name": "ALLY-ALIGN (FKA SPARTAN PLAN NJ, INC.)", "methodology": "fee schedule", "standard_charge_dollar": 504.61, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Americhoice (UHC)", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 480.58, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Amerihealth", "plan_name": "Amerihealth Medicare", "methodology": "fee schedule", "standard_charge_dollar": 480.58, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 706.21, "additional_payer_notes": "146.95% of Medicare Rates" }, { "payer_name": "Clover Health", "plan_name": "Clover Medicare", "methodology": "fee schedule", "standard_charge_dollar": 480.58, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Coventry", "plan_name": "Coventry Auto", "methodology": "fee schedule", "standard_charge_dollar": 961.16, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Coventry", "plan_name": "Coventry Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 961.16, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "fee schedule", "standard_charge_dollar": 672.81, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Fairprice Healthcare Holdings", "plan_name": "Fairprice Healthcare Holdings", "methodology": "fee schedule", "standard_charge_dollar": 768.93, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ HMO POS", "methodology": "fee schedule", "standard_charge_dollar": 852.07, "additional_payer_notes": "177.30% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ Indemnity", "methodology": "fee schedule", "standard_charge_dollar": 852.07, "additional_payer_notes": "177.30% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ PPO", "methodology": "fee schedule", "standard_charge_dollar": 852.07, "additional_payer_notes": "177.30% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon Medicare", "methodology": "fee schedule", "standard_charge_dollar": 480.58, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Military Tricare", "methodology": "fee schedule", "standard_charge_dollar": 384.46, "additional_payer_notes": "80.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 480.58, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 480.58, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC All Payer (02-01-2023 to 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 1636.94 }, { "payer_name": "UHC", "plan_name": "UHC Oxford (02-01-2023 to 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 1636.94 }, { "payer_name": "UHC - Adhoc", "plan_name": "UHC - Adhoc All Payer", "methodology": "case rate", "standard_charge_dollar": 1636.94 }, { "payer_name": "UHC - Adhoc", "plan_name": "UHC - Adhoc Oxford", "methodology": "case rate", "standard_charge_dollar": 1636.94 }, { "payer_name": "Wellcare", "plan_name": "Wellcare Insurance Exchange", "methodology": "fee schedule", "standard_charge_dollar": 648.78, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 480.58, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellchoice", "plan_name": "WELLCHOICE HMO of NJ (Empire) Commercial (HMO / HMO POS, PPO)", "methodology": "case rate", "standard_charge_dollar": 1636.94 }, { "payer_name": "Wellchoice", "plan_name": "WELLCHOICE HMO of NJ (Empire) Commercial (Indemnity)", "methodology": "case rate", "standard_charge_dollar": 1636.94 }, { "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup Medicare", "methodology": "fee schedule", "standard_charge_dollar": 480.58, "additional_payer_notes": "100.00% of Medicare Rates" } ] } ] }, { "description": "Hc Followup Eval Of Foot Pt Lop", "code_information": [ { "code": "G0246", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 183.0, "discounted_cash": 157.0, "minimum": 34.9347, "maximum": 183.0, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 183.0, "additional_payer_notes": "212.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medical Rental Network", "methodology": "fee schedule", "standard_charge_dollar": 183.0, "additional_payer_notes": "212.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 157.39, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "ALLY-ALIGN (FKA SPARTAN PLAN NJ, INC.)", "plan_name": "ALLY-ALIGN (FKA SPARTAN PLAN NJ, INC.)", "methodology": "fee schedule", "standard_charge_dollar": 165.26, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Americhoice (UHC)", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 157.39, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Amerihealth", "plan_name": "Amerihealth Medicare", "methodology": "fee schedule", "standard_charge_dollar": 157.39, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 183.0, "additional_payer_notes": "146.95% of Medicare Rates" }, { "payer_name": "Clover Health", "plan_name": "Clover Medicare", "methodology": "fee schedule", "standard_charge_dollar": 157.39, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Coventry", "plan_name": "Coventry Auto", "methodology": "fee schedule", "standard_charge_dollar": 183.0, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Coventry", "plan_name": "Coventry Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 183.0, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "fee schedule", "standard_charge_dollar": 183.0, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Fairprice Healthcare Holdings", "plan_name": "Fairprice Healthcare Holdings", "methodology": "fee schedule", "standard_charge_dollar": 183.0, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ HMO POS", "methodology": "fee schedule", "standard_charge_dollar": 183.0, "additional_payer_notes": "177.30% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ Indemnity", "methodology": "fee schedule", "standard_charge_dollar": 183.0, "additional_payer_notes": "177.30% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ PPO", "methodology": "fee schedule", "standard_charge_dollar": 183.0, "additional_payer_notes": "177.30% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon Medicare", "methodology": "fee schedule", "standard_charge_dollar": 157.39, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Military Tricare", "methodology": "fee schedule", "standard_charge_dollar": 125.91, "additional_payer_notes": "80.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 157.39, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 157.39, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Insurance Exchange", "methodology": "fee schedule", "standard_charge_dollar": 183.0, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 157.39, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup Medicare", "methodology": "fee schedule", "standard_charge_dollar": 157.39, "additional_payer_notes": "100.00% of Medicare Rates" } ] } ] }, { "description": "TRACHEOSTOMY FOR FACE, MOUTH AND NECK DIAGNOSES OR LARYNGECTOMY WITH CC", "code_information": [ { "code": "012", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 50278.0, "minimum": 23814.02, "maximum": 91004.628, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "case rate", "standard_charge_dollar": 91004.63, "additional_payer_notes": "181.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medical Rental Network", "methodology": "case rate", "standard_charge_dollar": 91004.63, "additional_payer_notes": "181.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "case rate", "standard_charge_dollar": 40679.2, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "ALLY-ALIGN (FKA SPARTAN PLAN NJ, INC.)", "plan_name": "ALLY-ALIGN (FKA SPARTAN PLAN NJ, INC.)", "methodology": "case rate", "standard_charge_dollar": 52792.74, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Americhoice (UHC)", "plan_name": "UHC Medicare", "methodology": "case rate", "standard_charge_dollar": 40679.2, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Amerihealth", "plan_name": "Amerihealth Medicare", "methodology": "case rate", "standard_charge_dollar": 40679.2, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Commercial", "methodology": "case rate", "standard_charge_dollar": 61680.08 }, { "payer_name": "Clover Health", "plan_name": "Clover Medicare", "methodology": "case rate", "standard_charge_dollar": 40679.2, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Coventry", "plan_name": "Coventry Auto", "methodology": "case rate", "standard_charge_dollar": 85473.96, "additional_payer_notes": "170.00% of Medicare Rates" }, { "payer_name": "Coventry", "plan_name": "Coventry Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 85473.96, "additional_payer_notes": "170.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "case rate", "standard_charge_dollar": 65362.44, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Fairprice Healthcare Holdings", "plan_name": "Fairprice Healthcare Holdings", "methodology": "case rate", "standard_charge_dollar": 80446.08, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon Medicare", "methodology": "case rate", "standard_charge_dollar": 40679.2, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon NJ Health Medicaid", "methodology": "case rate", "standard_charge_dollar": 23814.02 }, { "payer_name": "Humana", "plan_name": "Humana Military Tricare", "methodology": "case rate", "standard_charge_dollar": 40223.04, "additional_payer_notes": "80.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 50278.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 57418.3 }, { "payer_name": "UBH", "plan_name": "UBH Medicare", "methodology": "case rate", "standard_charge_dollar": 40679.2, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC All Payer (02-01-2023 to 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 71064.9 }, { "payer_name": "UHC", "plan_name": "UHC Oxford (02-01-2023 to 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 61933.04 }, { "payer_name": "UHC - Adhoc", "plan_name": "UHC - Adhoc All Payer", "methodology": "case rate", "standard_charge_dollar": 75436.89 }, { "payer_name": "UHC - Adhoc", "plan_name": "UHC - Adhoc Oxford", "methodology": "case rate", "standard_charge_dollar": 63821.81 }, { "payer_name": "Wellcare", "plan_name": "Wellcare Insurance Exchange", "methodology": "case rate", "standard_charge_dollar": 67876.38, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "case rate", "standard_charge_dollar": 40679.2, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup Medicare", "methodology": "case rate", "standard_charge_dollar": 40679.2, "additional_payer_notes": "100.00% of Medicare Rates" } ] } ] }, { "description": "NEONATE BWT 1000-1249G W RESP DIST SYNDOTH MAJ RESP OR MAJ ANOM - SOI : 2", "code_information": [ { "code": "6022", "type": "APR-DRG" } ], "standard_charges": [ { "setting": "inpatient", "minimum": 92779.22, "maximum": 102057.14, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Better Health - Medi Medi", "methodology": "case rate", "standard_charge_dollar": 102057.14, "additional_payer_notes": "110% of State Medicaid Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Better Health Medicaid", "methodology": "case rate", "standard_charge_dollar": 102057.14, "additional_payer_notes": "110% of State Medicaid Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "case rate", "standard_charge_dollar": 92779.22, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "UBH", "plan_name": "UBH Medicaid", "methodology": "case rate", "standard_charge_dollar": 92779.22, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicaid (02/01/2023 to 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 94634.8, "additional_payer_notes": "102% of State Medicaid Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicaid", "methodology": "case rate", "standard_charge_dollar": 92779.22, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup Medicaid", "methodology": "case rate", "standard_charge_dollar": 92779.22, "additional_payer_notes": "100% of State Medicaid Rates" } ] } ] }, { "description": "OSTEOMYELITIS, SEPTIC ARTHRITIS & OTHER MUSCULOSKELETAL INFECTIONS - SOI : 3", "code_information": [ { "code": "3443", "type": "APR-DRG" } ], "standard_charges": [ { "setting": "inpatient", "minimum": 15251.81, "maximum": 16776.99, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Better Health - Medi Medi", "methodology": "case rate", "standard_charge_dollar": 16776.99, "additional_payer_notes": "110% of State Medicaid Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Better Health Medicaid", "methodology": "case rate", "standard_charge_dollar": 16776.99, "additional_payer_notes": "110% of State Medicaid Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "case rate", "standard_charge_dollar": 15251.81, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "UBH", "plan_name": "UBH Medicaid", "methodology": "case rate", "standard_charge_dollar": 15251.81, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicaid (02/01/2023 to 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 15556.84, "additional_payer_notes": "102% of State Medicaid Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicaid", "methodology": "case rate", "standard_charge_dollar": 15251.81, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup Medicaid", "methodology": "case rate", "standard_charge_dollar": 15251.81, "additional_payer_notes": "100% of State Medicaid Rates" } ] } ] }, { "description": "Hc Speech Evaluation, Complex", "code_information": [ { "code": "70371", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 131.0, "discounted_cash": 282.0, "minimum": 25.0079, "maximum": 131.0, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 131.0, "additional_payer_notes": "212.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medical Rental Network", "methodology": "fee schedule", "standard_charge_dollar": 131.0, "additional_payer_notes": "212.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 131.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "ALLY-ALIGN (FKA SPARTAN PLAN NJ, INC.)", "plan_name": "ALLY-ALIGN (FKA SPARTAN PLAN NJ, INC.)", "methodology": "fee schedule", "standard_charge_dollar": 131.0, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Americhoice (UHC)", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 131.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Amerihealth", "plan_name": "Amerihealth HMO", "methodology": "fee schedule", "standard_charge_dollar": 131.0 }, { "payer_name": "Amerihealth", "plan_name": "Amerihealth Medicare", "methodology": "fee schedule", "standard_charge_dollar": 131.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 131.0, "additional_payer_notes": "146.95% of Medicare Rates" }, { "payer_name": "Clover Health", "plan_name": "Clover Medicare", "methodology": "fee schedule", "standard_charge_dollar": 131.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Coventry", "plan_name": "Coventry Auto", "methodology": "fee schedule", "standard_charge_dollar": 131.0, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Coventry", "plan_name": "Coventry Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 131.0, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "fee schedule", "standard_charge_dollar": 131.0, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Fairprice Healthcare Holdings", "plan_name": "Fairprice Healthcare Holdings", "methodology": "fee schedule", "standard_charge_dollar": 131.0, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ HMO POS", "methodology": "fee schedule", "standard_charge_dollar": 131.0, "additional_payer_notes": "177.30% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ Indemnity", "methodology": "fee schedule", "standard_charge_dollar": 131.0, "additional_payer_notes": "177.30% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ PPO", "methodology": "fee schedule", "standard_charge_dollar": 131.0, "additional_payer_notes": "177.30% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon Medicare", "methodology": "fee schedule", "standard_charge_dollar": 131.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Military Tricare", "methodology": "fee schedule", "standard_charge_dollar": 131.0, "additional_payer_notes": "80.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 131.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 131.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC All Payer (02-01-2023 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 131.0 }, { "payer_name": "UHC", "plan_name": "UHC Oxford (02-01-2023 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 131.0 }, { "payer_name": "UHC - Adhoc", "plan_name": "UHC - Adhoc All Payer", "methodology": "fee schedule", "standard_charge_dollar": 131.0 }, { "payer_name": "UHC - Adhoc", "plan_name": "UHC - Adhoc Oxford", "methodology": "fee schedule", "standard_charge_dollar": 131.0 }, { "payer_name": "Wellcare", "plan_name": "Wellcare Insurance Exchange", "methodology": "fee schedule", "standard_charge_dollar": 131.0, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 131.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup Medicare", "methodology": "fee schedule", "standard_charge_dollar": 131.0, "additional_payer_notes": "100.00% of Medicare Rates" } ] } ] }, { "description": "LYMPHATIC & OTHER MALIGNANCIES & NEOPLASMS OF UNCERTAIN BEHAVIOR - SOI : 1", "code_information": [ { "code": "6941", "type": "APR-DRG" } ], "standard_charges": [ { "setting": "inpatient", "minimum": 7619.46, "maximum": 8381.4, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Better Health - Medi Medi", "methodology": "case rate", "standard_charge_dollar": 8381.4, "additional_payer_notes": "110% of State Medicaid Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Better Health Medicaid", "methodology": "case rate", "standard_charge_dollar": 8381.4, "additional_payer_notes": "110% of State Medicaid Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "case rate", "standard_charge_dollar": 7619.46, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "UBH", "plan_name": "UBH Medicaid", "methodology": "case rate", "standard_charge_dollar": 7619.46, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicaid (02/01/2023 to 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 7771.84, "additional_payer_notes": "102% of State Medicaid Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicaid", "methodology": "case rate", "standard_charge_dollar": 7619.46, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup Medicaid", "methodology": "case rate", "standard_charge_dollar": 7619.46, "additional_payer_notes": "100% of State Medicaid Rates" } ] } ] }, { "description": "EYE INFECTIONS AND OTHER EYE DISORDERS - SOI : 3", "code_information": [ { "code": "0823", "type": "APR-DRG" } ], "standard_charges": [ { "setting": "inpatient", "minimum": 12207.1, "maximum": 13427.81, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Better Health - Medi Medi", "methodology": "case rate", "standard_charge_dollar": 13427.81, "additional_payer_notes": "110% of State Medicaid Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Better Health Medicaid", "methodology": "case rate", "standard_charge_dollar": 13427.81, "additional_payer_notes": "110% of State Medicaid Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "case rate", "standard_charge_dollar": 12207.1, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "UBH", "plan_name": "UBH Medicaid", "methodology": "case rate", "standard_charge_dollar": 12207.1, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicaid (02/01/2023 to 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 12451.24, "additional_payer_notes": "102% of State Medicaid Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicaid", "methodology": "case rate", "standard_charge_dollar": 12207.1, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup Medicaid", "methodology": "case rate", "standard_charge_dollar": 12207.1, "additional_payer_notes": "100% of State Medicaid Rates" } ] } ] }, { "description": "NEONATE W ECMO - SOI : 2", "code_information": [ { "code": "5832", "type": "APR-DRG" } ], "standard_charges": [ { "setting": "inpatient", "minimum": 244526.41, "maximum": 268979.05, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Better Health - Medi Medi", "methodology": "case rate", "standard_charge_dollar": 268979.05, "additional_payer_notes": "110% of State Medicaid Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Better Health Medicaid", "methodology": "case rate", "standard_charge_dollar": 268979.05, "additional_payer_notes": "110% of State Medicaid Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "case rate", "standard_charge_dollar": 244526.41, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "UBH", "plan_name": "UBH Medicaid", "methodology": "case rate", "standard_charge_dollar": 244526.41, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicaid (02/01/2023 to 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 249416.94, "additional_payer_notes": "102% of State Medicaid Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicaid", "methodology": "case rate", "standard_charge_dollar": 244526.41, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup Medicaid", "methodology": "case rate", "standard_charge_dollar": 244526.41, "additional_payer_notes": "100% of State Medicaid Rates" } ] } ] }, { "description": "Hc Prq Drug Eluting Cor Revasc Chro Add - C9608 - 48100200", "code_information": [ { "code": "C9608", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 13800.0, "minimum": 2297.0, "maximum": 11040.0, "payers_information": [ { "payer_name": "UHC", "plan_name": "UHC All Payer (02-01-2023 to 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 3057.0 }, { "payer_name": "UHC", "plan_name": "UHC Oxford (02-01-2023 to 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 2297.0 }, { "payer_name": "UHC - Adhoc", "plan_name": "UHC - Adhoc All Payer", "methodology": "case rate", "standard_charge_dollar": 3245.0 }, { "payer_name": "UHC - Adhoc", "plan_name": "UHC - Adhoc Oxford", "methodology": "case rate", "standard_charge_dollar": 2367.0 }, { "payer_name": "Wellchoice", "plan_name": "WELLCHOICE HMO of NJ (Empire) Commercial (HMO / HMO POS, PPO)", "methodology": "case rate", "standard_charge_dollar": 2472.0 }, { "payer_name": "Wellchoice", "plan_name": "WELLCHOICE HMO of NJ (Empire) Commercial (Indemnity)", "methodology": "case rate", "standard_charge_dollar": 2753.0 } ] } ] }, { "description": "POST-OPERATIVE, POST-TRAUMATIC, OTHER DEVICE INFECTIONS - SOI : 3", "code_information": [ { "code": "7213", "type": "APR-DRG" } ], "standard_charges": [ { "setting": "inpatient", "minimum": 14562.19, "maximum": 16018.41, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Better Health - Medi Medi", "methodology": "case rate", "standard_charge_dollar": 16018.41, "additional_payer_notes": "110% of State Medicaid Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Better Health Medicaid", "methodology": "case rate", "standard_charge_dollar": 16018.41, "additional_payer_notes": "110% of State Medicaid Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "case rate", "standard_charge_dollar": 14562.19, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "UBH", "plan_name": "UBH Medicaid", "methodology": "case rate", "standard_charge_dollar": 14562.19, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicaid (02/01/2023 to 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 14853.43, "additional_payer_notes": "102% of State Medicaid Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicaid", "methodology": "case rate", "standard_charge_dollar": 14562.19, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup Medicaid", "methodology": "case rate", "standard_charge_dollar": 14562.19, "additional_payer_notes": "100% of State Medicaid Rates" } ] } ] }, { "description": "RENAL DIALYSIS ACCESS DEVICE PROCEDURES- SOI : 4", "code_information": [ { "code": "4444", "type": "APR-DRG" } ], "standard_charges": [ { "setting": "inpatient", "minimum": 42794.5, "maximum": 47073.95, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Better Health - Medi Medi", "methodology": "case rate", "standard_charge_dollar": 47073.95, "additional_payer_notes": "110% of State Medicaid Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Better Health Medicaid", "methodology": "case rate", "standard_charge_dollar": 47073.95, "additional_payer_notes": "110% of State Medicaid Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "case rate", "standard_charge_dollar": 42794.5, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "UBH", "plan_name": "UBH Medicaid", "methodology": "case rate", "standard_charge_dollar": 42794.5, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicaid (02/01/2023 to 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 43650.39, "additional_payer_notes": "102% of State Medicaid Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicaid", "methodology": "case rate", "standard_charge_dollar": 42794.5, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup Medicaid", "methodology": "case rate", "standard_charge_dollar": 42794.5, "additional_payer_notes": "100% of State Medicaid Rates" } ] } ] }, { "description": "Hc Remove Impacted Ear Wax Uni", "code_information": [ { "code": "69209", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 251.09, "discounted_cash": 69.0, "minimum": 47.9331, "maximum": 251.09, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 147.85, "additional_payer_notes": "212.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medical Rental Network", "methodology": "fee schedule", "standard_charge_dollar": 147.85, "additional_payer_notes": "212.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 69.74, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "ALLY-ALIGN (FKA SPARTAN PLAN NJ, INC.)", "plan_name": "ALLY-ALIGN (FKA SPARTAN PLAN NJ, INC.)", "methodology": "fee schedule", "standard_charge_dollar": 73.23, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Americhoice (UHC)", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 69.74, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Amerihealth", "plan_name": "Amerihealth Medicare", "methodology": "fee schedule", "standard_charge_dollar": 69.74, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 102.48, "additional_payer_notes": "146.95% of Medicare Rates" }, { "payer_name": "Clover Health", "plan_name": "Clover Medicare", "methodology": "fee schedule", "standard_charge_dollar": 69.74, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Coventry", "plan_name": "Coventry Auto", "methodology": "fee schedule", "standard_charge_dollar": 139.48, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Coventry", "plan_name": "Coventry Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 139.48, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "fee schedule", "standard_charge_dollar": 97.64, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Fairprice Healthcare Holdings", "plan_name": "Fairprice Healthcare Holdings", "methodology": "fee schedule", "standard_charge_dollar": 111.58, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ HMO POS", "methodology": "fee schedule", "standard_charge_dollar": 123.65, "additional_payer_notes": "177.30% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ Indemnity", "methodology": "fee schedule", "standard_charge_dollar": 123.65, "additional_payer_notes": "177.30% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ PPO", "methodology": "fee schedule", "standard_charge_dollar": 123.65, "additional_payer_notes": "177.30% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon Medicare", "methodology": "fee schedule", "standard_charge_dollar": 69.74, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Military Tricare", "methodology": "fee schedule", "standard_charge_dollar": 55.79, "additional_payer_notes": "80.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 69.74, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 69.74, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC All Payer (02-01-2023 to 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 251.09 }, { "payer_name": "UHC", "plan_name": "UHC Oxford (02-01-2023 to 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 251.09 }, { "payer_name": "UHC - Adhoc", "plan_name": "UHC - Adhoc All Payer", "methodology": "case rate", "standard_charge_dollar": 251.09 }, { "payer_name": "UHC - Adhoc", "plan_name": "UHC - Adhoc Oxford", "methodology": "case rate", "standard_charge_dollar": 251.09 }, { "payer_name": "Wellcare", "plan_name": "Wellcare Insurance Exchange", "methodology": "fee schedule", "standard_charge_dollar": 94.15, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 69.74, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup Medicare", "methodology": "fee schedule", "standard_charge_dollar": 69.74, "additional_payer_notes": "100.00% of Medicare Rates" } ] } ] }, { "description": "Hc Alpha-1-Antitrypsin, Pheno", "code_information": [ { "code": "82104", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 42.0, "discounted_cash": 14.0, "minimum": 8.0178, "maximum": 35.7, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 30.66, "additional_payer_notes": "212.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medical Rental Network", "methodology": "fee schedule", "standard_charge_dollar": 30.66, "additional_payer_notes": "212.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 14.46, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "ALLY-ALIGN (FKA SPARTAN PLAN NJ, INC.)", "plan_name": "ALLY-ALIGN (FKA SPARTAN PLAN NJ, INC.)", "methodology": "fee schedule", "standard_charge_dollar": 15.18, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Americhoice (UHC)", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 14.46, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Amerihealth", "plan_name": "Amerihealth Medicare", "methodology": "fee schedule", "standard_charge_dollar": 14.46, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 20.97, "additional_payer_notes": "Laboratory - 145.00% of Medicare Rates" }, { "payer_name": "Clover Health", "plan_name": "Clover Medicare", "methodology": "fee schedule", "standard_charge_dollar": 14.46, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Coventry", "plan_name": "Coventry Auto", "methodology": "fee schedule", "standard_charge_dollar": 28.92, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Coventry", "plan_name": "Coventry Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 28.92, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "fee schedule", "standard_charge_dollar": 20.24, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Fairprice Healthcare Holdings", "plan_name": "Fairprice Healthcare Holdings", "methodology": "fee schedule", "standard_charge_dollar": 17.35, "additional_payer_notes": "Laboratory - 120.00% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ HMO POS", "methodology": "fee schedule", "standard_charge_dollar": 29.65, "additional_payer_notes": "177.30% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ Indemnity", "methodology": "fee schedule", "standard_charge_dollar": 29.65, "additional_payer_notes": "177.30% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ PPO", "methodology": "fee schedule", "standard_charge_dollar": 29.65, "additional_payer_notes": "177.30% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon Medicare", "methodology": "fee schedule", "standard_charge_dollar": 14.46, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Military Tricare", "methodology": "fee schedule", "standard_charge_dollar": 11.57, "additional_payer_notes": "80.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 14.46, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 14.46, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC All Payer (02-01-2023 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 8.68 }, { "payer_name": "UHC", "plan_name": "UHC Medicaid (02/01/2023 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 11.57 }, { "payer_name": "UHC", "plan_name": "UHC Oxford (02-01-2023 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 8.68 }, { "payer_name": "UHC - Adhoc", "plan_name": "UHC - Adhoc All Payer", "methodology": "fee schedule", "standard_charge_dollar": 14.46 }, { "payer_name": "UHC - Adhoc", "plan_name": "UHC - Adhoc Oxford", "methodology": "fee schedule", "standard_charge_dollar": 14.46 }, { "payer_name": "Wellcare", "plan_name": "Wellcare Insurance Exchange", "methodology": "fee schedule", "standard_charge_dollar": 19.52, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 14.46, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup Medicare", "methodology": "fee schedule", "standard_charge_dollar": 14.46, "additional_payer_notes": "100.00% of Medicare Rates" } ] } ] }, { "description": "Hc Bamlanivimab And Etesevimab Infusion And Monitoring", "code_information": [ { "code": "M0245", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 1548.0, "discounted_cash": 521.0, "minimum": 295.5132, "maximum": 1315.8, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 450.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "ALLY-ALIGN (FKA SPARTAN PLAN NJ, INC.)", "plan_name": "ALLY-ALIGN (FKA SPARTAN PLAN NJ, INC.)", "methodology": "fee schedule", "standard_charge_dollar": 547.34, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Americhoice (UHC)", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 521.28, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Amerihealth", "plan_name": "Amerihealth Medicare", "methodology": "fee schedule", "standard_charge_dollar": 521.28, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 766.02, "additional_payer_notes": "146.95% of Medicare Rates" }, { "payer_name": "Clover Health", "plan_name": "Clover Medicare", "methodology": "fee schedule", "standard_charge_dollar": 521.28, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Coventry", "plan_name": "Coventry Auto", "methodology": "fee schedule", "standard_charge_dollar": 1042.56, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Coventry", "plan_name": "Coventry Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 1042.56, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "fee schedule", "standard_charge_dollar": 729.79, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Fairprice Healthcare Holdings", "plan_name": "Fairprice Healthcare Holdings", "methodology": "fee schedule", "standard_charge_dollar": 834.05, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ HMO POS", "methodology": "fee schedule", "standard_charge_dollar": 924.23, "additional_payer_notes": "177.30% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ Indemnity", "methodology": "fee schedule", "standard_charge_dollar": 924.23, "additional_payer_notes": "177.30% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ PPO", "methodology": "fee schedule", "standard_charge_dollar": 924.23, "additional_payer_notes": "177.30% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon Medicare", "methodology": "fee schedule", "standard_charge_dollar": 521.28, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Military Tricare", "methodology": "fee schedule", "standard_charge_dollar": 417.02, "additional_payer_notes": "80.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 521.28, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 521.28, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Insurance Exchange", "methodology": "fee schedule", "standard_charge_dollar": 703.73, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 521.28, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup Medicare", "methodology": "fee schedule", "standard_charge_dollar": 521.28, "additional_payer_notes": "100.00% of Medicare Rates" } ] } ] }, { "description": "Myomectomy Abdom Complex", "code_information": [ { "code": "58146", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 32729.3, "minimum": 1139.67, "maximum": 26183.44, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1139.67, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ PPO", "methodology": "percent of total billed charges", "standard_charge_percentage": 70.6, "standard_charge_algorithm": "Not To Exceed $9269", "additional_payer_notes": "Not to exceed limits in contract for this procedure", "median_amount": 8999.0, "10th_percentile": 8999.0, "90th_percentile": 8999.0, "count": "1 through 10" }, { "payer_name": "UHC", "plan_name": "UHC All Payer (02-01-2023 to 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 5378.0 }, { "payer_name": "UHC", "plan_name": "UHC Oxford (02-01-2023 to 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 5169.0 }, { "payer_name": "UHC - Adhoc", "plan_name": "UHC - Adhoc All Payer", "methodology": "case rate", "standard_charge_dollar": 5709.0 }, { "payer_name": "UHC - Adhoc", "plan_name": "UHC - Adhoc Oxford", "methodology": "case rate", "standard_charge_dollar": 5327.0 }, { "payer_name": "Wellchoice", "plan_name": "WELLCHOICE HMO of NJ (Empire) Commercial (HMO / HMO POS, PPO)", "methodology": "case rate", "standard_charge_dollar": 1715.0 }, { "payer_name": "Wellchoice", "plan_name": "WELLCHOICE HMO of NJ (Empire) Commercial (Indemnity)", "methodology": "case rate", "standard_charge_dollar": 1978.0 } ] } ] }, { "description": "NEONATE BWT 2000-2499G W RESP DIST SYNDOTH MAJ RESP COND - SOI : 2", "code_information": [ { "code": "6222", "type": "APR-DRG" } ], "standard_charges": [ { "setting": "inpatient", "minimum": 26938.13, "maximum": 29631.95, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Better Health - Medi Medi", "methodology": "case rate", "standard_charge_dollar": 29631.95, "additional_payer_notes": "110% of State Medicaid Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Better Health Medicaid", "methodology": "case rate", "standard_charge_dollar": 29631.95, "additional_payer_notes": "110% of State Medicaid Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "case rate", "standard_charge_dollar": 26938.13, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "UBH", "plan_name": "UBH Medicaid", "methodology": "case rate", "standard_charge_dollar": 26938.13, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicaid (02/01/2023 to 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 27476.89, "additional_payer_notes": "102% of State Medicaid Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicaid", "methodology": "case rate", "standard_charge_dollar": 26938.13, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup Medicaid", "methodology": "case rate", "standard_charge_dollar": 26938.13, "additional_payer_notes": "100% of State Medicaid Rates" } ] } ] }, { "description": "KIDNEY AND URETER PROCEDURES FOR NON-NEOPLASM WITH MCC", "code_information": [ { "code": "659", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 30920.0, "minimum": 17028.92, "maximum": 55966.1955, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "case rate", "standard_charge_dollar": 55966.2, "additional_payer_notes": "181.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medical Rental Network", "methodology": "case rate", "standard_charge_dollar": 55966.2, "additional_payer_notes": "181.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "case rate", "standard_charge_dollar": 25135.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "ALLY-ALIGN (FKA SPARTAN PLAN NJ, INC.)", "plan_name": "ALLY-ALIGN (FKA SPARTAN PLAN NJ, INC.)", "methodology": "case rate", "standard_charge_dollar": 32466.58, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Americhoice (UHC)", "plan_name": "UHC Medicare", "methodology": "case rate", "standard_charge_dollar": 25135.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Amerihealth", "plan_name": "Amerihealth Medicare", "methodology": "case rate", "standard_charge_dollar": 25135.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Commercial", "methodology": "case rate", "standard_charge_dollar": 37173.37 }, { "payer_name": "Clover Health", "plan_name": "Clover Medicare", "methodology": "case rate", "standard_charge_dollar": 25135.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Coventry", "plan_name": "Coventry Auto", "methodology": "case rate", "standard_charge_dollar": 52564.94, "additional_payer_notes": "170.00% of Medicare Rates" }, { "payer_name": "Coventry", "plan_name": "Coventry Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 52564.94, "additional_payer_notes": "170.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "case rate", "standard_charge_dollar": 40196.72, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Fairprice Healthcare Holdings", "plan_name": "Fairprice Healthcare Holdings", "methodology": "case rate", "standard_charge_dollar": 49472.88, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon Medicare", "methodology": "case rate", "standard_charge_dollar": 25135.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon NJ Health Medicaid", "methodology": "case rate", "standard_charge_dollar": 17028.92 }, { "payer_name": "Humana", "plan_name": "Humana Military Tricare", "methodology": "case rate", "standard_charge_dollar": 24736.44, "additional_payer_notes": "80.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 30920.55, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 31309.0 }, { "payer_name": "UBH", "plan_name": "UBH Medicare", "methodology": "case rate", "standard_charge_dollar": 25135.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC All Payer (02-01-2023 to 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 42829.41 }, { "payer_name": "UHC", "plan_name": "UHC Oxford (02-01-2023 to 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 37325.82 }, { "payer_name": "UHC - Adhoc", "plan_name": "UHC - Adhoc All Payer", "methodology": "case rate", "standard_charge_dollar": 45464.32 }, { "payer_name": "UHC - Adhoc", "plan_name": "UHC - Adhoc Oxford", "methodology": "case rate", "standard_charge_dollar": 38464.14 }, { "payer_name": "Wellcare", "plan_name": "Wellcare Insurance Exchange", "methodology": "case rate", "standard_charge_dollar": 41742.74, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "case rate", "standard_charge_dollar": 25135.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup Medicare", "methodology": "case rate", "standard_charge_dollar": 25135.1, "additional_payer_notes": "100.00% of Medicare Rates" } ] } ] }, { "description": "Hc Assay Of Creatinine", "code_information": [ { "code": "82565", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 89.0, "discounted_cash": 5.0, "minimum": 3.07, "maximum": 75.65, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 10.85, "additional_payer_notes": "212.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medical Rental Network", "methodology": "fee schedule", "standard_charge_dollar": 10.85, "additional_payer_notes": "212.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5.12, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "ALLY-ALIGN (FKA SPARTAN PLAN NJ, INC.)", "plan_name": "ALLY-ALIGN (FKA SPARTAN PLAN NJ, INC.)", "methodology": "fee schedule", "standard_charge_dollar": 5.38, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Americhoice (UHC)", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5.12, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Amerihealth", "plan_name": "Amerihealth Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5.12, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 7.42, "additional_payer_notes": "Laboratory - 145.00% of Medicare Rates" }, { "payer_name": "Clover Health", "plan_name": "Clover Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5.12, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Coventry", "plan_name": "Coventry Auto", "methodology": "fee schedule", "standard_charge_dollar": 10.24, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Coventry", "plan_name": "Coventry Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 10.24, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "fee schedule", "standard_charge_dollar": 7.17, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Fairprice Healthcare Holdings", "plan_name": "Fairprice Healthcare Holdings", "methodology": "fee schedule", "standard_charge_dollar": 6.14, "additional_payer_notes": "Laboratory - 120.00% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ HMO POS", "methodology": "fee schedule", "standard_charge_dollar": 62.83, "additional_payer_notes": "177.30% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ Indemnity", "methodology": "fee schedule", "standard_charge_dollar": 62.83, "additional_payer_notes": "177.30% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ PPO", "methodology": "fee schedule", "standard_charge_dollar": 62.83, "additional_payer_notes": "177.30% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5.12, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Military Tricare", "methodology": "fee schedule", "standard_charge_dollar": 4.1, "additional_payer_notes": "80.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5.12, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 5.12, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC All Payer (02-01-2023 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 3.07 }, { "payer_name": "UHC", "plan_name": "UHC Medicaid (02/01/2023 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 4.1 }, { "payer_name": "UHC", "plan_name": "UHC Oxford (02-01-2023 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 3.07 }, { "payer_name": "UHC - Adhoc", "plan_name": "UHC - Adhoc All Payer", "methodology": "fee schedule", "standard_charge_dollar": 5.12 }, { "payer_name": "UHC - Adhoc", "plan_name": "UHC - Adhoc Oxford", "methodology": "fee schedule", "standard_charge_dollar": 5.12 }, { "payer_name": "Wellcare", "plan_name": "Wellcare Insurance Exchange", "methodology": "fee schedule", "standard_charge_dollar": 6.91, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5.12, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup Medicaid", "methodology": "percent of total billed charges", "standard_charge_percentage": 19.09, "median_amount": 16.6, "10th_percentile": 16.6, "90th_percentile": 16.6, "count": "1 through 10" }, { "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5.12, "additional_payer_notes": "100.00% of Medicare Rates" } ] } ] }, { "description": "Hc Stent Des Each Add Branch", "code_information": [ { "code": "C9601", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 16664.5, "minimum": 2297.0, "maximum": 13331.6, "payers_information": [ { "payer_name": "Horizon", "plan_name": "Horizon NJ Health Medicaid", "methodology": "percent of total billed charges", "standard_charge_percentage": 19.58, "median_amount": 3262.92, "10th_percentile": 3262.92, "90th_percentile": 3262.92, "count": "1 through 10" }, { "payer_name": "UHC", "plan_name": "UHC All Payer (02-01-2023 to 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 3057.0 }, { "payer_name": "UHC", "plan_name": "UHC Oxford (02-01-2023 to 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 2297.0 }, { "payer_name": "UHC - Adhoc", "plan_name": "UHC - Adhoc All Payer", "methodology": "case rate", "standard_charge_dollar": 3245.0 }, { "payer_name": "UHC - Adhoc", "plan_name": "UHC - Adhoc Oxford", "methodology": "case rate", "standard_charge_dollar": 2367.0 }, { "payer_name": "Wellchoice", "plan_name": "WELLCHOICE HMO of NJ (Empire) Commercial (HMO / HMO POS, PPO)", "methodology": "case rate", "standard_charge_dollar": 2472.0 }, { "payer_name": "Wellchoice", "plan_name": "WELLCHOICE HMO of NJ (Empire) Commercial (Indemnity)", "methodology": "case rate", "standard_charge_dollar": 2753.0 } ] } ] }, { "description": "SPLENECTOMY - SOI : 2", "code_information": [ { "code": "6502", "type": "APR-DRG" } ], "standard_charges": [ { "setting": "inpatient", "minimum": 22952.44, "maximum": 25247.69, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Better Health Medicaid", "methodology": "case rate", "standard_charge_dollar": 25247.69, "additional_payer_notes": "110% of State Medicaid Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "case rate", "standard_charge_dollar": 22952.44, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "UBH", "plan_name": "UBH Medicaid", "methodology": "case rate", "standard_charge_dollar": 22952.44, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicaid (02/01/2023 to 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 23411.49, "additional_payer_notes": "102% of State Medicaid Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicaid", "methodology": "case rate", "standard_charge_dollar": 22952.44, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup Medicaid", "methodology": "case rate", "standard_charge_dollar": 22952.44, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Better Health - Medi Medi", "methodology": "case rate", "standard_charge_dollar": 25247.69, "additional_payer_notes": "110% of State Medicaid Rates" } ] } ] }, { "description": "Hc Cholecystostomy,Percutaneous, Complete", "code_information": [ { "code": "47490", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 15545.0, "discounted_cash": 4232.0, "minimum": 1715.0, "maximum": 12436.0, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 8973.47, "additional_payer_notes": "212.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medical Rental Network", "methodology": "fee schedule", "standard_charge_dollar": 8973.47, "additional_payer_notes": "212.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 4232.77, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "ALLY-ALIGN (FKA SPARTAN PLAN NJ, INC.)", "plan_name": "ALLY-ALIGN (FKA SPARTAN PLAN NJ, INC.)", "methodology": "fee schedule", "standard_charge_dollar": 4444.41, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Americhoice (UHC)", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 4232.77, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Amerihealth", "plan_name": "Amerihealth Medicare", "methodology": "fee schedule", "standard_charge_dollar": 4232.77, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 6220.06, "additional_payer_notes": "146.95% of Medicare Rates" }, { "payer_name": "Clover Health", "plan_name": "Clover Medicare", "methodology": "fee schedule", "standard_charge_dollar": 4232.77, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Coventry", "plan_name": "Coventry Auto", "methodology": "fee schedule", "standard_charge_dollar": 8465.54, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Coventry", "plan_name": "Coventry Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 8465.54, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "fee schedule", "standard_charge_dollar": 5925.88, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Fairprice Healthcare Holdings", "plan_name": "Fairprice Healthcare Holdings", "methodology": "fee schedule", "standard_charge_dollar": 6772.43, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ HMO POS", "methodology": "fee schedule", "standard_charge_dollar": 7504.7, "additional_payer_notes": "177.30% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ Indemnity", "methodology": "fee schedule", "standard_charge_dollar": 7504.7, "additional_payer_notes": "177.30% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ PPO", "methodology": "fee schedule", "standard_charge_dollar": 7504.7, "additional_payer_notes": "177.30% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon Medicare", "methodology": "fee schedule", "standard_charge_dollar": 4232.77, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Military Tricare", "methodology": "fee schedule", "standard_charge_dollar": 3386.22, "additional_payer_notes": "80.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 4232.77, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 4232.77, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC All Payer (02-01-2023 to 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 5378.0 }, { "payer_name": "UHC", "plan_name": "UHC Oxford (02-01-2023 to 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 5169.0 }, { "payer_name": "UHC - Adhoc", "plan_name": "UHC - Adhoc All Payer", "methodology": "case rate", "standard_charge_dollar": 5709.0 }, { "payer_name": "UHC - Adhoc", "plan_name": "UHC - Adhoc Oxford", "methodology": "case rate", "standard_charge_dollar": 5327.0 }, { "payer_name": "Wellcare", "plan_name": "Wellcare Insurance Exchange", "methodology": "fee schedule", "standard_charge_dollar": 5714.24, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 4232.77, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellchoice", "plan_name": "WELLCHOICE HMO of NJ (Empire) Commercial (HMO / HMO POS, PPO)", "methodology": "case rate", "standard_charge_dollar": 1715.0 }, { "payer_name": "Wellchoice", "plan_name": "WELLCHOICE HMO of NJ (Empire) Commercial (Indemnity)", "methodology": "case rate", "standard_charge_dollar": 1978.0 }, { "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup Medicare", "methodology": "fee schedule", "standard_charge_dollar": 4232.77, "additional_payer_notes": "100.00% of Medicare Rates" } ] } ] }, { "description": "CELLULITIS & OTHER SKIN INFECTIONS - SOI : 3", "code_information": [ { "code": "3833", "type": "APR-DRG" } ], "standard_charges": [ { "setting": "inpatient", "minimum": 11272.6, "maximum": 12399.86, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Better Health - Medi Medi", "methodology": "case rate", "standard_charge_dollar": 12399.86, "additional_payer_notes": "110% of State Medicaid Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Better Health Medicaid", "methodology": "case rate", "standard_charge_dollar": 12399.86, "additional_payer_notes": "110% of State Medicaid Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "case rate", "standard_charge_dollar": 11272.6, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "UBH", "plan_name": "UBH Medicaid", "methodology": "case rate", "standard_charge_dollar": 11272.6, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicaid (02/01/2023 to 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 11498.05, "additional_payer_notes": "102% of State Medicaid Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicaid", "methodology": "case rate", "standard_charge_dollar": 11272.6, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup Medicaid", "methodology": "case rate", "standard_charge_dollar": 11272.6, "additional_payer_notes": "100% of State Medicaid Rates" } ] } ] }, { "description": "Rpr Aa Hrn Rcr < 3 Rdc", "code_information": [ { "code": "49613", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 25965.0, "discounted_cash": 4232.0, "minimum": 1715.0, "maximum": 20772.0, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 8973.47, "additional_payer_notes": "212.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medical Rental Network", "methodology": "fee schedule", "standard_charge_dollar": 8973.47, "additional_payer_notes": "212.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 4232.77, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "ALLY-ALIGN (FKA SPARTAN PLAN NJ, INC.)", "plan_name": "ALLY-ALIGN (FKA SPARTAN PLAN NJ, INC.)", "methodology": "fee schedule", "standard_charge_dollar": 4444.41, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Americhoice (UHC)", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 4232.77, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Amerihealth", "plan_name": "Amerihealth Medicare", "methodology": "fee schedule", "standard_charge_dollar": 4232.77, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 6220.06, "additional_payer_notes": "146.95% of Medicare Rates" }, { "payer_name": "Clover Health", "plan_name": "Clover Medicare", "methodology": "fee schedule", "standard_charge_dollar": 4232.77, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Coventry", "plan_name": "Coventry Auto", "methodology": "fee schedule", "standard_charge_dollar": 8465.54, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Coventry", "plan_name": "Coventry Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 8465.54, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "fee schedule", "standard_charge_dollar": 5925.88, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Fairprice Healthcare Holdings", "plan_name": "Fairprice Healthcare Holdings", "methodology": "fee schedule", "standard_charge_dollar": 6772.43, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ HMO POS", "methodology": "fee schedule", "standard_charge_dollar": 7504.7, "additional_payer_notes": "177.30% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ Indemnity", "methodology": "fee schedule", "standard_charge_dollar": 7504.7, "additional_payer_notes": "177.30% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ PPO", "methodology": "fee schedule", "standard_charge_dollar": 7504.7, "additional_payer_notes": "177.30% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon Medicare", "methodology": "fee schedule", "standard_charge_dollar": 4232.77, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Military Tricare", "methodology": "fee schedule", "standard_charge_dollar": 3386.22, "additional_payer_notes": "80.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 4232.77, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 4232.77, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC All Payer (02-01-2023 to 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 5378.0 }, { "payer_name": "UHC", "plan_name": "UHC Oxford (02-01-2023 to 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 5169.0 }, { "payer_name": "UHC - Adhoc", "plan_name": "UHC - Adhoc All Payer", "methodology": "case rate", "standard_charge_dollar": 5709.0 }, { "payer_name": "UHC - Adhoc", "plan_name": "UHC - Adhoc Oxford", "methodology": "case rate", "standard_charge_dollar": 5327.0 }, { "payer_name": "Wellcare", "plan_name": "Wellcare Insurance Exchange", "methodology": "fee schedule", "standard_charge_dollar": 5714.24, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 4232.77, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellchoice", "plan_name": "WELLCHOICE HMO of NJ (Empire) Commercial (HMO / HMO POS, PPO)", "methodology": "case rate", "standard_charge_dollar": 1715.0 }, { "payer_name": "Wellchoice", "plan_name": "WELLCHOICE HMO of NJ (Empire) Commercial (Indemnity)", "methodology": "case rate", "standard_charge_dollar": 1978.0 }, { "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup Medicare", "methodology": "fee schedule", "standard_charge_dollar": 4232.77, "additional_payer_notes": "100.00% of Medicare Rates" } ] } ] }, { "description": "OTHER HEPATOBILIARY, PANCREAS & ABDOMINAL PROCEDURES - SOI : 3", "code_information": [ { "code": "2643", "type": "APR-DRG" } ], "standard_charges": [ { "setting": "inpatient", "minimum": 26738.35, "maximum": 29412.19, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Better Health - Medi Medi", "methodology": "case rate", "standard_charge_dollar": 29412.19, "additional_payer_notes": "110% of State Medicaid Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Better Health Medicaid", "methodology": "case rate", "standard_charge_dollar": 29412.19, "additional_payer_notes": "110% of State Medicaid Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "case rate", "standard_charge_dollar": 26738.35, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "UBH", "plan_name": "UBH Medicaid", "methodology": "case rate", "standard_charge_dollar": 26738.35, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicaid (02/01/2023 to 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 27273.12, "additional_payer_notes": "102% of State Medicaid Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicaid", "methodology": "case rate", "standard_charge_dollar": 26738.35, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup Medicaid", "methodology": "case rate", "standard_charge_dollar": 26738.35, "additional_payer_notes": "100% of State Medicaid Rates" } ] } ] }, { "description": "O.R. PROCEDURES WITH DIAGNOSES OF OTHER CONTACT WITH HEALTH SERVICES WITH MCC", "code_information": [ { "code": "939", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 43489.0, "minimum": 20473.3, "maximum": 78715.7597, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "case rate", "standard_charge_dollar": 78715.76, "additional_payer_notes": "181.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medical Rental Network", "methodology": "case rate", "standard_charge_dollar": 78715.76, "additional_payer_notes": "181.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "case rate", "standard_charge_dollar": 35227.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "ALLY-ALIGN (FKA SPARTAN PLAN NJ, INC.)", "plan_name": "ALLY-ALIGN (FKA SPARTAN PLAN NJ, INC.)", "methodology": "case rate", "standard_charge_dollar": 45663.84, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Americhoice (UHC)", "plan_name": "UHC Medicare", "methodology": "case rate", "standard_charge_dollar": 35227.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Amerihealth", "plan_name": "Amerihealth Medicare", "methodology": "case rate", "standard_charge_dollar": 35227.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Commercial", "methodology": "case rate", "standard_charge_dollar": 53084.96 }, { "payer_name": "Clover Health", "plan_name": "Clover Medicare", "methodology": "case rate", "standard_charge_dollar": 35227.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Coventry", "plan_name": "Coventry Auto", "methodology": "case rate", "standard_charge_dollar": 73931.93, "additional_payer_notes": "170.00% of Medicare Rates" }, { "payer_name": "Coventry", "plan_name": "Coventry Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 73931.93, "additional_payer_notes": "170.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "case rate", "standard_charge_dollar": 56536.18, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Fairprice Healthcare Holdings", "plan_name": "Fairprice Healthcare Holdings", "methodology": "case rate", "standard_charge_dollar": 69582.99, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon Medicare", "methodology": "case rate", "standard_charge_dollar": 35227.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon NJ Health Medicaid", "methodology": "case rate", "standard_charge_dollar": 20473.3 }, { "payer_name": "Humana", "plan_name": "Humana Military Tricare", "methodology": "case rate", "standard_charge_dollar": 34791.5, "additional_payer_notes": "80.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 43489.37, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 40945.3 }, { "payer_name": "UBH", "plan_name": "UBH Medicare", "methodology": "case rate", "standard_charge_dollar": 35227.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC All Payer (02-01-2023 to 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 61162.0 }, { "payer_name": "UHC", "plan_name": "UHC Oxford (02-01-2023 to 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 53302.67 }, { "payer_name": "UHC - Adhoc", "plan_name": "UHC - Adhoc All Payer", "methodology": "case rate", "standard_charge_dollar": 64924.75 }, { "payer_name": "UHC - Adhoc", "plan_name": "UHC - Adhoc Oxford", "methodology": "case rate", "standard_charge_dollar": 54928.23 }, { "payer_name": "Wellcare", "plan_name": "Wellcare Insurance Exchange", "methodology": "case rate", "standard_charge_dollar": 58710.65, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "case rate", "standard_charge_dollar": 35227.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup Medicare", "methodology": "case rate", "standard_charge_dollar": 35227.5, "additional_payer_notes": "100.00% of Medicare Rates" } ] } ] }, { "description": "UTERINE & ADNEXA PROCEDURES FOR OVARIAN & ADNEXAL MALIGNANCY - SOI : 1", "code_information": [ { "code": "5111", "type": "APR-DRG" } ], "standard_charges": [ { "setting": "inpatient", "minimum": 17203.39, "maximum": 18923.73, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Better Health - Medi Medi", "methodology": "case rate", "standard_charge_dollar": 18923.73, "additional_payer_notes": "110% of State Medicaid Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Better Health Medicaid", "methodology": "case rate", "standard_charge_dollar": 18923.73, "additional_payer_notes": "110% of State Medicaid Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "case rate", "standard_charge_dollar": 17203.39, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "UBH", "plan_name": "UBH Medicaid", "methodology": "case rate", "standard_charge_dollar": 17203.39, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicaid (02/01/2023 to 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 17547.46, "additional_payer_notes": "102% of State Medicaid Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicaid", "methodology": "case rate", "standard_charge_dollar": 17203.39, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup Medicaid", "methodology": "case rate", "standard_charge_dollar": 17203.39, "additional_payer_notes": "100% of State Medicaid Rates" } ] } ] }, { "description": "Fusion of big toe joint - 28755 - ", "code_information": [ { "code": "28755", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 8384.53, "discounted_cash": 8578.0, "minimum": 1600.6068, "maximum": 8384.53, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 8384.53, "additional_payer_notes": "212.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medical Rental Network", "methodology": "fee schedule", "standard_charge_dollar": 8384.53, "additional_payer_notes": "212.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 8384.53, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "ALLY-ALIGN (FKA SPARTAN PLAN NJ, INC.)", "plan_name": "ALLY-ALIGN (FKA SPARTAN PLAN NJ, INC.)", "methodology": "fee schedule", "standard_charge_dollar": 8384.53, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Americhoice (UHC)", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 8384.53, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Amerihealth", "plan_name": "Amerihealth Medicare", "methodology": "fee schedule", "standard_charge_dollar": 8384.53, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 8384.53, "additional_payer_notes": "146.95% of Medicare Rates" }, { "payer_name": "Clover Health", "plan_name": "Clover Medicare", "methodology": "fee schedule", "standard_charge_dollar": 8384.53, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Coventry", "plan_name": "Coventry Auto", "methodology": "fee schedule", "standard_charge_dollar": 8384.53, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Coventry", "plan_name": "Coventry Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 8384.53, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "fee schedule", "standard_charge_dollar": 8384.53, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Fairprice Healthcare Holdings", "plan_name": "Fairprice Healthcare Holdings", "methodology": "fee schedule", "standard_charge_dollar": 8384.53, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ HMO POS", "methodology": "fee schedule", "standard_charge_dollar": 8384.53, "additional_payer_notes": "177.30% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ Indemnity", "methodology": "fee schedule", "standard_charge_dollar": 8384.53, "additional_payer_notes": "177.30% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ PPO", "methodology": "fee schedule", "standard_charge_dollar": 8384.53, "additional_payer_notes": "177.30% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon Medicare", "methodology": "fee schedule", "standard_charge_dollar": 8384.53, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Military Tricare", "methodology": "fee schedule", "standard_charge_dollar": 6862.66, "additional_payer_notes": "80.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 8384.53, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 8384.53, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC All Payer (02-01-2023 to 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 4415.0 }, { "payer_name": "UHC", "plan_name": "UHC Oxford (02-01-2023 to 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 4020.0 }, { "payer_name": "UHC - Adhoc", "plan_name": "UHC - Adhoc All Payer", "methodology": "case rate", "standard_charge_dollar": 4687.0 }, { "payer_name": "UHC - Adhoc", "plan_name": "UHC - Adhoc Oxford", "methodology": "case rate", "standard_charge_dollar": 4143.0 }, { "payer_name": "Wellcare", "plan_name": "Wellcare Insurance Exchange", "methodology": "fee schedule", "standard_charge_dollar": 8384.53, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 8384.53, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellchoice", "plan_name": "WELLCHOICE HMO of NJ (Empire) Commercial (HMO / HMO POS, PPO)", "methodology": "case rate", "standard_charge_dollar": 1715.0 }, { "payer_name": "Wellchoice", "plan_name": "WELLCHOICE HMO of NJ (Empire) Commercial (Indemnity)", "methodology": "case rate", "standard_charge_dollar": 1978.0 }, { "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup Medicare", "methodology": "fee schedule", "standard_charge_dollar": 8384.53, "additional_payer_notes": "100.00% of Medicare Rates" } ] } ] }, { "description": "Hc R&L Heart Cath Inj Vetriculography, Rs/I", "code_information": [ { "code": "93453", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 14096.3, "discounted_cash": 3832.0, "minimum": 2472.0, "maximum": 11277.04, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 8125.18, "additional_payer_notes": "212.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medical Rental Network", "methodology": "fee schedule", "standard_charge_dollar": 8125.18, "additional_payer_notes": "212.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3832.63, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "ALLY-ALIGN (FKA SPARTAN PLAN NJ, INC.)", "plan_name": "ALLY-ALIGN (FKA SPARTAN PLAN NJ, INC.)", "methodology": "fee schedule", "standard_charge_dollar": 4024.26, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Americhoice (UHC)", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3832.63, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Amerihealth", "plan_name": "Amerihealth Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3832.63, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 5632.05, "additional_payer_notes": "146.95% of Medicare Rates" }, { "payer_name": "Clover Health", "plan_name": "Clover Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3832.63, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Coventry", "plan_name": "Coventry Auto", "methodology": "fee schedule", "standard_charge_dollar": 7665.26, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Coventry", "plan_name": "Coventry Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 7665.26, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "fee schedule", "standard_charge_dollar": 5365.68, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Fairprice Healthcare Holdings", "plan_name": "Fairprice Healthcare Holdings", "methodology": "fee schedule", "standard_charge_dollar": 6132.21, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ HMO POS", "methodology": "fee schedule", "standard_charge_dollar": 6795.25, "additional_payer_notes": "177.30% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ Indemnity", "methodology": "fee schedule", "standard_charge_dollar": 6795.25, "additional_payer_notes": "177.30% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ PPO", "methodology": "fee schedule", "standard_charge_dollar": 6795.25, "additional_payer_notes": "177.30% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3832.63, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Military Tricare", "methodology": "fee schedule", "standard_charge_dollar": 3066.1, "additional_payer_notes": "80.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3832.63, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 3832.63, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC All Payer (02-01-2023 to 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 5667.0 }, { "payer_name": "UHC", "plan_name": "UHC Oxford (02-01-2023 to 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 5169.0 }, { "payer_name": "UHC - Adhoc", "plan_name": "UHC - Adhoc All Payer", "methodology": "case rate", "standard_charge_dollar": 6016.0 }, { "payer_name": "UHC - Adhoc", "plan_name": "UHC - Adhoc Oxford", "methodology": "case rate", "standard_charge_dollar": 5327.0 }, { "payer_name": "Wellcare", "plan_name": "Wellcare Insurance Exchange", "methodology": "fee schedule", "standard_charge_dollar": 5174.05, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3832.63, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellchoice", "plan_name": "WELLCHOICE HMO of NJ (Empire) Commercial (HMO / HMO POS, PPO)", "methodology": "case rate", "standard_charge_dollar": 2472.0 }, { "payer_name": "Wellchoice", "plan_name": "WELLCHOICE HMO of NJ (Empire) Commercial (Indemnity)", "methodology": "case rate", "standard_charge_dollar": 2753.0 }, { "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3832.63, "additional_payer_notes": "100.00% of Medicare Rates" } ] } ] }, { "description": "OTHER DISORDERS OF NERVOUS SYSTEM - SOI : 3", "code_information": [ { "code": "0583", "type": "APR-DRG" } ], "standard_charges": [ { "setting": "inpatient", "minimum": 17007.49, "maximum": 18708.23, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Better Health - Medi Medi", "methodology": "case rate", "standard_charge_dollar": 18708.23, "additional_payer_notes": "110% of State Medicaid Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Better Health Medicaid", "methodology": "case rate", "standard_charge_dollar": 18708.23, "additional_payer_notes": "110% of State Medicaid Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "case rate", "standard_charge_dollar": 17007.49, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "UBH", "plan_name": "UBH Medicaid", "methodology": "case rate", "standard_charge_dollar": 17007.49, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicaid (02/01/2023 to 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 17347.64, "additional_payer_notes": "102% of State Medicaid Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicaid", "methodology": "case rate", "standard_charge_dollar": 17007.49, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup Medicaid", "methodology": "case rate", "standard_charge_dollar": 17007.49, "additional_payer_notes": "100% of State Medicaid Rates" } ] } ] }, { "description": "Hc Assay Of Cyclosporine", "code_information": [ { "code": "80158", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 117.0, "discounted_cash": 18.0, "minimum": 10.83, "maximum": 99.45, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 38.27, "additional_payer_notes": "212.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medical Rental Network", "methodology": "fee schedule", "standard_charge_dollar": 38.27, "additional_payer_notes": "212.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 18.05, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "ALLY-ALIGN (FKA SPARTAN PLAN NJ, INC.)", "plan_name": "ALLY-ALIGN (FKA SPARTAN PLAN NJ, INC.)", "methodology": "fee schedule", "standard_charge_dollar": 18.95, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Americhoice (UHC)", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 18.05, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Amerihealth", "plan_name": "Amerihealth Medicare", "methodology": "fee schedule", "standard_charge_dollar": 18.05, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 26.17, "additional_payer_notes": "Laboratory - 145.00% of Medicare Rates" }, { "payer_name": "Clover Health", "plan_name": "Clover Medicare", "methodology": "fee schedule", "standard_charge_dollar": 18.05, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Coventry", "plan_name": "Coventry Auto", "methodology": "fee schedule", "standard_charge_dollar": 36.1, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Coventry", "plan_name": "Coventry Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 36.1, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "fee schedule", "standard_charge_dollar": 25.27, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Fairprice Healthcare Holdings", "plan_name": "Fairprice Healthcare Holdings", "methodology": "fee schedule", "standard_charge_dollar": 21.66, "additional_payer_notes": "Laboratory - 120.00% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ HMO POS", "methodology": "fee schedule", "standard_charge_dollar": 82.6, "additional_payer_notes": "177.30% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ Indemnity", "methodology": "fee schedule", "standard_charge_dollar": 82.6, "additional_payer_notes": "177.30% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ PPO", "methodology": "fee schedule", "standard_charge_dollar": 82.6, "additional_payer_notes": "177.30% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon Medicare", "methodology": "fee schedule", "standard_charge_dollar": 18.05, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Military Tricare", "methodology": "fee schedule", "standard_charge_dollar": 14.44, "additional_payer_notes": "80.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 18.05, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 18.05, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC All Payer (02-01-2023 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 10.83 }, { "payer_name": "UHC", "plan_name": "UHC Medicaid (02/01/2023 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 14.44 }, { "payer_name": "UHC", "plan_name": "UHC Oxford (02-01-2023 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 10.83 }, { "payer_name": "UHC - Adhoc", "plan_name": "UHC - Adhoc All Payer", "methodology": "fee schedule", "standard_charge_dollar": 18.05 }, { "payer_name": "UHC - Adhoc", "plan_name": "UHC - Adhoc Oxford", "methodology": "fee schedule", "standard_charge_dollar": 18.05 }, { "payer_name": "Wellcare", "plan_name": "Wellcare Insurance Exchange", "methodology": "fee schedule", "standard_charge_dollar": 24.37, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 18.05, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup Medicare", "methodology": "fee schedule", "standard_charge_dollar": 18.05, "additional_payer_notes": "100.00% of Medicare Rates" } ] } ] }, { "description": "Knee Arthroscopy/Surgery - 29880 - OR36029880", "code_information": [ { "code": "29880", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 30187.8, "discounted_cash": 3868.0, "minimum": 1715.0, "maximum": 24150.24, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 8200.52, "additional_payer_notes": "212.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medical Rental Network", "methodology": "fee schedule", "standard_charge_dollar": 8200.52, "additional_payer_notes": "212.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3868.17, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "ALLY-ALIGN (FKA SPARTAN PLAN NJ, INC.)", "plan_name": "ALLY-ALIGN (FKA SPARTAN PLAN NJ, INC.)", "methodology": "fee schedule", "standard_charge_dollar": 4061.58, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Americhoice (UHC)", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3868.17, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Amerihealth", "plan_name": "Amerihealth Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3868.17, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 5684.28, "additional_payer_notes": "146.95% of Medicare Rates" }, { "payer_name": "Clover Health", "plan_name": "Clover Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3868.17, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Coventry", "plan_name": "Coventry Auto", "methodology": "fee schedule", "standard_charge_dollar": 7736.34, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Coventry", "plan_name": "Coventry Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 7736.34, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "fee schedule", "standard_charge_dollar": 5415.44, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Fairprice Healthcare Holdings", "plan_name": "Fairprice Healthcare Holdings", "methodology": "fee schedule", "standard_charge_dollar": 6189.07, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ HMO POS", "methodology": "fee schedule", "standard_charge_dollar": 6858.27, "additional_payer_notes": "177.30% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ Indemnity", "methodology": "fee schedule", "standard_charge_dollar": 6858.27, "additional_payer_notes": "177.30% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ PPO", "methodology": "fee schedule", "standard_charge_dollar": 6858.27, "additional_payer_notes": "177.30% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3868.17, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Military Tricare", "methodology": "fee schedule", "standard_charge_dollar": 3094.54, "additional_payer_notes": "80.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3868.17, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 3868.17, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC All Payer (02-01-2023 to 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 5378.0 }, { "payer_name": "UHC", "plan_name": "UHC Oxford (02-01-2023 to 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 5169.0 }, { "payer_name": "UHC - Adhoc", "plan_name": "UHC - Adhoc All Payer", "methodology": "case rate", "standard_charge_dollar": 5709.0 }, { "payer_name": "UHC - Adhoc", "plan_name": "UHC - Adhoc Oxford", "methodology": "case rate", "standard_charge_dollar": 5327.0 }, { "payer_name": "Wellcare", "plan_name": "Wellcare Insurance Exchange", "methodology": "fee schedule", "standard_charge_dollar": 5222.03, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3868.17, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellchoice", "plan_name": "WELLCHOICE HMO of NJ (Empire) Commercial (HMO / HMO POS, PPO)", "methodology": "case rate", "standard_charge_dollar": 1715.0 }, { "payer_name": "Wellchoice", "plan_name": "WELLCHOICE HMO of NJ (Empire) Commercial (Indemnity)", "methodology": "case rate", "standard_charge_dollar": 1978.0 }, { "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3868.17, "additional_payer_notes": "100.00% of Medicare Rates" } ] } ] }, { "description": "CARDIAC ARRHYTHMIA AND CONDUCTION DISORDERS WITH CC", "code_information": [ { "code": "309", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 10058.0, "minimum": 4767.55, "maximum": 18206.4461, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "case rate", "standard_charge_dollar": 18206.45, "additional_payer_notes": "181.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medical Rental Network", "methodology": "case rate", "standard_charge_dollar": 18206.45, "additional_payer_notes": "181.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "case rate", "standard_charge_dollar": 8383.67, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "ALLY-ALIGN (FKA SPARTAN PLAN NJ, INC.)", "plan_name": "ALLY-ALIGN (FKA SPARTAN PLAN NJ, INC.)", "methodology": "case rate", "standard_charge_dollar": 10561.75, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Americhoice (UHC)", "plan_name": "UHC Medicare", "methodology": "case rate", "standard_charge_dollar": 8383.67, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Amerihealth", "plan_name": "Amerihealth Medicare", "methodology": "case rate", "standard_charge_dollar": 8383.67, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Commercial", "methodology": "case rate", "standard_charge_dollar": 10763.29 }, { "payer_name": "Clover Health", "plan_name": "Clover Medicare", "methodology": "case rate", "standard_charge_dollar": 8383.67, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Coventry", "plan_name": "Coventry Auto", "methodology": "case rate", "standard_charge_dollar": 17099.98, "additional_payer_notes": "170.00% of Medicare Rates" }, { "payer_name": "Coventry", "plan_name": "Coventry Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 17099.98, "additional_payer_notes": "170.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "case rate", "standard_charge_dollar": 13076.45, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Fairprice Healthcare Holdings", "plan_name": "Fairprice Healthcare Holdings", "methodology": "case rate", "standard_charge_dollar": 16094.1, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon Medicare", "methodology": "case rate", "standard_charge_dollar": 8383.67, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon NJ Health Medicaid", "methodology": "case rate", "standard_charge_dollar": 4767.55 }, { "payer_name": "Humana", "plan_name": "Humana Military Tricare", "methodology": "case rate", "standard_charge_dollar": 8047.05, "additional_payer_notes": "80.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 10058.81, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 6958.57 }, { "payer_name": "UBH", "plan_name": "UBH Medicare", "methodology": "case rate", "standard_charge_dollar": 8383.67, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC All Payer (02-01-2023 to 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 12400.96 }, { "payer_name": "UHC", "plan_name": "UHC Oxford (02-01-2023 to 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 10807.43 }, { "payer_name": "UHC - Adhoc", "plan_name": "UHC - Adhoc All Payer", "methodology": "case rate", "standard_charge_dollar": 13163.88 }, { "payer_name": "UHC - Adhoc", "plan_name": "UHC - Adhoc Oxford", "methodology": "case rate", "standard_charge_dollar": 11137.03 }, { "payer_name": "Wellcare", "plan_name": "Wellcare Insurance Exchange", "methodology": "case rate", "standard_charge_dollar": 13579.39, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "case rate", "standard_charge_dollar": 8383.67, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup Medicare", "methodology": "case rate", "standard_charge_dollar": 8383.67, "additional_payer_notes": "100.00% of Medicare Rates" } ] } ] }, { "description": "O.R. PROCEDURES WITH DIAGNOSES OF OTHER CONTACT WITH HEALTH SERVICES WITHOUT CCMCC", "code_information": [ { "code": "941", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 24989.0, "minimum": 11560.76, "maximum": 45231.4837, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "case rate", "standard_charge_dollar": 45231.48, "additional_payer_notes": "181.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medical Rental Network", "methodology": "case rate", "standard_charge_dollar": 45231.48, "additional_payer_notes": "181.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "case rate", "standard_charge_dollar": 20372.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "ALLY-ALIGN (FKA SPARTAN PLAN NJ, INC.)", "plan_name": "ALLY-ALIGN (FKA SPARTAN PLAN NJ, INC.)", "methodology": "case rate", "standard_charge_dollar": 26239.26, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Americhoice (UHC)", "plan_name": "UHC Medicare", "methodology": "case rate", "standard_charge_dollar": 20372.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Amerihealth", "plan_name": "Amerihealth Medicare", "methodology": "case rate", "standard_charge_dollar": 20372.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Commercial", "methodology": "case rate", "standard_charge_dollar": 29665.25 }, { "payer_name": "Clover Health", "plan_name": "Clover Medicare", "methodology": "case rate", "standard_charge_dollar": 20372.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Coventry", "plan_name": "Coventry Auto", "methodology": "case rate", "standard_charge_dollar": 42482.61, "additional_payer_notes": "170.00% of Medicare Rates" }, { "payer_name": "Coventry", "plan_name": "Coventry Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 42482.61, "additional_payer_notes": "170.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "case rate", "standard_charge_dollar": 32486.7, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Fairprice Healthcare Holdings", "plan_name": "Fairprice Healthcare Holdings", "methodology": "case rate", "standard_charge_dollar": 39983.63, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon Medicare", "methodology": "case rate", "standard_charge_dollar": 20372.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon NJ Health Medicaid", "methodology": "case rate", "standard_charge_dollar": 11560.76 }, { "payer_name": "Humana", "plan_name": "Humana Military Tricare", "methodology": "case rate", "standard_charge_dollar": 19991.82, "additional_payer_notes": "80.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 24989.77, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 19402.5 }, { "payer_name": "UBH", "plan_name": "UBH Medicare", "methodology": "case rate", "standard_charge_dollar": 20372.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC All Payer (02-01-2023 to 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 34178.91 }, { "payer_name": "UHC", "plan_name": "UHC Oxford (02-01-2023 to 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 29786.91 }, { "payer_name": "UHC - Adhoc", "plan_name": "UHC - Adhoc All Payer", "methodology": "case rate", "standard_charge_dollar": 36281.64 }, { "payer_name": "UHC - Adhoc", "plan_name": "UHC - Adhoc Oxford", "methodology": "case rate", "standard_charge_dollar": 30695.32 }, { "payer_name": "Wellcare", "plan_name": "Wellcare Insurance Exchange", "methodology": "case rate", "standard_charge_dollar": 33736.19, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "case rate", "standard_charge_dollar": 20372.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup Medicare", "methodology": "case rate", "standard_charge_dollar": 20372.8, "additional_payer_notes": "100.00% of Medicare Rates" } ] } ] }, { "description": "Hc Assay Of Progesterone", "code_information": [ { "code": "84144", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 156.0, "discounted_cash": 20.0, "minimum": 12.52, "maximum": 132.6, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 44.22, "additional_payer_notes": "212.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medical Rental Network", "methodology": "fee schedule", "standard_charge_dollar": 44.22, "additional_payer_notes": "212.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 20.86, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "ALLY-ALIGN (FKA SPARTAN PLAN NJ, INC.)", "plan_name": "ALLY-ALIGN (FKA SPARTAN PLAN NJ, INC.)", "methodology": "fee schedule", "standard_charge_dollar": 21.9, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Americhoice (UHC)", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 20.86, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Amerihealth", "plan_name": "Amerihealth Medicare", "methodology": "fee schedule", "standard_charge_dollar": 20.86, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 30.25, "additional_payer_notes": "Laboratory - 145.00% of Medicare Rates" }, { "payer_name": "Clover Health", "plan_name": "Clover Medicare", "methodology": "fee schedule", "standard_charge_dollar": 20.86, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Coventry", "plan_name": "Coventry Auto", "methodology": "fee schedule", "standard_charge_dollar": 41.72, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Coventry", "plan_name": "Coventry Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 41.72, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "fee schedule", "standard_charge_dollar": 29.2, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Fairprice Healthcare Holdings", "plan_name": "Fairprice Healthcare Holdings", "methodology": "fee schedule", "standard_charge_dollar": 25.03, "additional_payer_notes": "Laboratory - 120.00% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ HMO POS", "methodology": "fee schedule", "standard_charge_dollar": 110.14, "additional_payer_notes": "177.30% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ Indemnity", "methodology": "fee schedule", "standard_charge_dollar": 110.14, "additional_payer_notes": "177.30% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ PPO", "methodology": "fee schedule", "standard_charge_dollar": 110.14, "additional_payer_notes": "177.30% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon Medicare", "methodology": "fee schedule", "standard_charge_dollar": 20.86, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Military Tricare", "methodology": "fee schedule", "standard_charge_dollar": 16.69, "additional_payer_notes": "80.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 20.86, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 20.86, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC All Payer (02-01-2023 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 12.52 }, { "payer_name": "UHC", "plan_name": "UHC Medicaid (02/01/2023 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 16.69 }, { "payer_name": "UHC", "plan_name": "UHC Oxford (02-01-2023 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 12.52 }, { "payer_name": "UHC - Adhoc", "plan_name": "UHC - Adhoc All Payer", "methodology": "fee schedule", "standard_charge_dollar": 20.86 }, { "payer_name": "UHC - Adhoc", "plan_name": "UHC - Adhoc Oxford", "methodology": "fee schedule", "standard_charge_dollar": 20.86 }, { "payer_name": "Wellcare", "plan_name": "Wellcare Insurance Exchange", "methodology": "fee schedule", "standard_charge_dollar": 28.16, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 20.86, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup Medicare", "methodology": "fee schedule", "standard_charge_dollar": 20.86, "additional_payer_notes": "100.00% of Medicare Rates" } ] } ] }, { "description": "Hc Glucose Blood Test", "code_information": [ { "code": "82962", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 16.5, "discounted_cash": 3.0, "minimum": 1.97, "maximum": 14.025, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 6.95, "additional_payer_notes": "212.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medical Rental Network", "methodology": "fee schedule", "standard_charge_dollar": 6.95, "additional_payer_notes": "212.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3.28, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "ALLY-ALIGN (FKA SPARTAN PLAN NJ, INC.)", "plan_name": "ALLY-ALIGN (FKA SPARTAN PLAN NJ, INC.)", "methodology": "fee schedule", "standard_charge_dollar": 3.44, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Americhoice (UHC)", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3.28, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Amerihealth", "plan_name": "Amerihealth Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3.28, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 4.76, "additional_payer_notes": "Laboratory - 145.00% of Medicare Rates" }, { "payer_name": "Clover Health", "plan_name": "Clover Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3.28, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Coventry", "plan_name": "Coventry Auto", "methodology": "fee schedule", "standard_charge_dollar": 6.56, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Coventry", "plan_name": "Coventry Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 6.56, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "fee schedule", "standard_charge_dollar": 4.59, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Fairprice Healthcare Holdings", "plan_name": "Fairprice Healthcare Holdings", "methodology": "fee schedule", "standard_charge_dollar": 3.94, "additional_payer_notes": "Laboratory - 120.00% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ HMO POS", "methodology": "fee schedule", "standard_charge_dollar": 11.65, "additional_payer_notes": "177.30% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ Indemnity", "methodology": "fee schedule", "standard_charge_dollar": 11.65, "additional_payer_notes": "177.30% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ PPO", "methodology": "fee schedule", "standard_charge_dollar": 11.65, "additional_payer_notes": "177.30% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3.28, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Military Tricare", "methodology": "fee schedule", "standard_charge_dollar": 2.62, "additional_payer_notes": "80.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3.28, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 3.28, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC All Payer (02-01-2023 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 1.97 }, { "payer_name": "UHC", "plan_name": "UHC Medicaid (02/01/2023 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 2.62 }, { "payer_name": "UHC", "plan_name": "UHC Oxford (02-01-2023 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 1.97 }, { "payer_name": "UHC - Adhoc", "plan_name": "UHC - Adhoc All Payer", "methodology": "fee schedule", "standard_charge_dollar": 3.28 }, { "payer_name": "UHC - Adhoc", "plan_name": "UHC - Adhoc Oxford", "methodology": "fee schedule", "standard_charge_dollar": 3.28 }, { "payer_name": "Wellcare", "plan_name": "Wellcare Insurance Exchange", "methodology": "fee schedule", "standard_charge_dollar": 4.43, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3.28, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup Medicaid", "methodology": "percent of total billed charges", "standard_charge_percentage": 19.09, "median_amount": 3.08, "10th_percentile": 3.08, "90th_percentile": 3.28, "count": "1 through 10" }, { "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3.28, "additional_payer_notes": "100.00% of Medicare Rates" } ] } ] }, { "description": "FRACTURE, SPRAIN, STRAIN AND DISLOCATION EXCEPT FEMUR, HIP, PELVIS AND THIGH WITHOUT MCC", "code_information": [ { "code": "563", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 11905.0, "minimum": 5233.38, "maximum": 21549.0274, "payers_information": [ { "payer_name": "ALLY-ALIGN (FKA SPARTAN PLAN NJ, INC.)", "plan_name": "ALLY-ALIGN (FKA SPARTAN PLAN NJ, INC.)", "methodology": "case rate", "standard_charge_dollar": 12500.82, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Americhoice (UHC)", "plan_name": "UHC Medicare", "methodology": "case rate", "standard_charge_dollar": 9866.54, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Amerihealth", "plan_name": "Amerihealth Medicare", "methodology": "case rate", "standard_charge_dollar": 9866.54, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Commercial", "methodology": "case rate", "standard_charge_dollar": 13101.17 }, { "payer_name": "Clover Health", "plan_name": "Clover Medicare", "methodology": "case rate", "standard_charge_dollar": 9866.54, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Coventry", "plan_name": "Coventry Auto", "methodology": "case rate", "standard_charge_dollar": 20239.42, "additional_payer_notes": "170.00% of Medicare Rates" }, { "payer_name": "Coventry", "plan_name": "Coventry Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 20239.42, "additional_payer_notes": "170.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "case rate", "standard_charge_dollar": 15477.2, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Fairprice Healthcare Holdings", "plan_name": "Fairprice Healthcare Holdings", "methodology": "case rate", "standard_charge_dollar": 19048.86, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon Medicare", "methodology": "case rate", "standard_charge_dollar": 9866.54, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon NJ Health Medicaid", "methodology": "case rate", "standard_charge_dollar": 5233.38 }, { "payer_name": "Humana", "plan_name": "Humana Military Tricare", "methodology": "case rate", "standard_charge_dollar": 9524.43, "additional_payer_notes": "80.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 11905.54, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 9640.28 }, { "payer_name": "UBH", "plan_name": "UBH Medicare", "methodology": "case rate", "standard_charge_dollar": 9866.54, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC All Payer (02-01-2023 to 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 15094.55 }, { "payer_name": "UHC", "plan_name": "UHC Oxford (02-01-2023 to 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 13154.9 }, { "payer_name": "UHC - Adhoc", "plan_name": "UHC - Adhoc All Payer", "methodology": "case rate", "standard_charge_dollar": 16023.18 }, { "payer_name": "UHC - Adhoc", "plan_name": "UHC - Adhoc Oxford", "methodology": "case rate", "standard_charge_dollar": 13556.08 }, { "payer_name": "Wellcare", "plan_name": "Wellcare Insurance Exchange", "methodology": "case rate", "standard_charge_dollar": 16072.48, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "case rate", "standard_charge_dollar": 9866.54, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup Medicare", "methodology": "case rate", "standard_charge_dollar": 9866.54, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "case rate", "standard_charge_dollar": 21549.03, "additional_payer_notes": "181.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medical Rental Network", "methodology": "case rate", "standard_charge_dollar": 21549.03, "additional_payer_notes": "181.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "case rate", "standard_charge_dollar": 9866.54, "additional_payer_notes": "100.00% of Medicare Rates" } ] } ] }, { "description": "CIRRHOSIS AND ALCOHOLIC HEPATITIS WITH MCC", "code_information": [ { "code": "432", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 24302.0, "minimum": 11402.15, "maximum": 43986.9096, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "case rate", "standard_charge_dollar": 43986.91, "additional_payer_notes": "181.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medical Rental Network", "methodology": "case rate", "standard_charge_dollar": 43986.91, "additional_payer_notes": "181.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "case rate", "standard_charge_dollar": 19820.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "ALLY-ALIGN (FKA SPARTAN PLAN NJ, INC.)", "plan_name": "ALLY-ALIGN (FKA SPARTAN PLAN NJ, INC.)", "methodology": "case rate", "standard_charge_dollar": 25517.27, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Americhoice (UHC)", "plan_name": "UHC Medicare", "methodology": "case rate", "standard_charge_dollar": 19820.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Amerihealth", "plan_name": "Amerihealth Medicare", "methodology": "case rate", "standard_charge_dollar": 19820.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Commercial", "methodology": "case rate", "standard_charge_dollar": 28794.77 }, { "payer_name": "Clover Health", "plan_name": "Clover Medicare", "methodology": "case rate", "standard_charge_dollar": 19820.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Coventry", "plan_name": "Coventry Auto", "methodology": "case rate", "standard_charge_dollar": 41313.67, "additional_payer_notes": "170.00% of Medicare Rates" }, { "payer_name": "Coventry", "plan_name": "Coventry Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 41313.67, "additional_payer_notes": "170.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "case rate", "standard_charge_dollar": 31592.81, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Fairprice Healthcare Holdings", "plan_name": "Fairprice Healthcare Holdings", "methodology": "case rate", "standard_charge_dollar": 38883.46, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon Medicare", "methodology": "case rate", "standard_charge_dollar": 19820.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon NJ Health Medicaid", "methodology": "case rate", "standard_charge_dollar": 11402.15 }, { "payer_name": "Humana", "plan_name": "Humana Military Tricare", "methodology": "case rate", "standard_charge_dollar": 19441.73, "additional_payer_notes": "80.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 24302.16, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 25965.2 }, { "payer_name": "UBH", "plan_name": "UBH Medicare", "methodology": "case rate", "standard_charge_dollar": 19820.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC All Payer (02-01-2023 to 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 33175.98 }, { "payer_name": "UHC", "plan_name": "UHC Oxford (02-01-2023 to 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 28912.86 }, { "payer_name": "UHC - Adhoc", "plan_name": "UHC - Adhoc All Payer", "methodology": "case rate", "standard_charge_dollar": 35217.0 }, { "payer_name": "UHC - Adhoc", "plan_name": "UHC - Adhoc Oxford", "methodology": "case rate", "standard_charge_dollar": 29794.61 }, { "payer_name": "Wellcare", "plan_name": "Wellcare Insurance Exchange", "methodology": "case rate", "standard_charge_dollar": 32807.92, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "case rate", "standard_charge_dollar": 19820.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup Medicare", "methodology": "case rate", "standard_charge_dollar": 19820.7, "additional_payer_notes": "100.00% of Medicare Rates" } ] } ] }, { "description": "RESPIRATORY SIGNS, SYMPTOMS AND MISCELLANEOUS DIAGNOSES- SOI : 2", "code_information": [ { "code": "1442", "type": "APR-DRG" } ], "standard_charges": [ { "setting": "inpatient", "minimum": 8071.94, "maximum": 8879.13, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Better Health - Medi Medi", "methodology": "case rate", "standard_charge_dollar": 8879.13, "additional_payer_notes": "110% of State Medicaid Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Better Health Medicaid", "methodology": "case rate", "standard_charge_dollar": 8879.13, "additional_payer_notes": "110% of State Medicaid Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "case rate", "standard_charge_dollar": 8071.94, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "UBH", "plan_name": "UBH Medicaid", "methodology": "case rate", "standard_charge_dollar": 8071.94, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicaid (02/01/2023 to 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 8233.38, "additional_payer_notes": "102% of State Medicaid Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicaid", "methodology": "case rate", "standard_charge_dollar": 8071.94, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup Medicaid", "methodology": "case rate", "standard_charge_dollar": 8071.94, "additional_payer_notes": "100% of State Medicaid Rates" } ] } ] }, { "description": "Hc Injection; Spider Veins,Limb/Trunk", "code_information": [ { "code": "36468", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 1457.46, "discounted_cash": 480.0, "minimum": 278.2291, "maximum": 1457.46, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 1018.83, "additional_payer_notes": "212.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medical Rental Network", "methodology": "fee schedule", "standard_charge_dollar": 1018.83, "additional_payer_notes": "212.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 480.58, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "ALLY-ALIGN (FKA SPARTAN PLAN NJ, INC.)", "plan_name": "ALLY-ALIGN (FKA SPARTAN PLAN NJ, INC.)", "methodology": "fee schedule", "standard_charge_dollar": 504.61, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Americhoice (UHC)", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 480.58, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Amerihealth", "plan_name": "Amerihealth Medicare", "methodology": "fee schedule", "standard_charge_dollar": 480.58, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 706.21, "additional_payer_notes": "146.95% of Medicare Rates" }, { "payer_name": "Clover Health", "plan_name": "Clover Medicare", "methodology": "fee schedule", "standard_charge_dollar": 480.58, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Coventry", "plan_name": "Coventry Auto", "methodology": "fee schedule", "standard_charge_dollar": 961.16, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Coventry", "plan_name": "Coventry Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 961.16, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "fee schedule", "standard_charge_dollar": 672.81, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Fairprice Healthcare Holdings", "plan_name": "Fairprice Healthcare Holdings", "methodology": "fee schedule", "standard_charge_dollar": 768.93, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ HMO POS", "methodology": "fee schedule", "standard_charge_dollar": 852.07, "additional_payer_notes": "177.30% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ Indemnity", "methodology": "fee schedule", "standard_charge_dollar": 852.07, "additional_payer_notes": "177.30% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ PPO", "methodology": "fee schedule", "standard_charge_dollar": 852.07, "additional_payer_notes": "177.30% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon Medicare", "methodology": "fee schedule", "standard_charge_dollar": 480.58, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Military Tricare", "methodology": "fee schedule", "standard_charge_dollar": 384.46, "additional_payer_notes": "80.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 480.58, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 480.58, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC All Payer (02-01-2023 to 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 1457.46 }, { "payer_name": "UHC", "plan_name": "UHC Oxford (02-01-2023 to 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 1457.46 }, { "payer_name": "UHC - Adhoc", "plan_name": "UHC - Adhoc All Payer", "methodology": "case rate", "standard_charge_dollar": 1457.46 }, { "payer_name": "UHC - Adhoc", "plan_name": "UHC - Adhoc Oxford", "methodology": "case rate", "standard_charge_dollar": 1457.46 }, { "payer_name": "Wellcare", "plan_name": "Wellcare Insurance Exchange", "methodology": "fee schedule", "standard_charge_dollar": 648.78, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 480.58, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellchoice", "plan_name": "WELLCHOICE HMO of NJ (Empire) Commercial (HMO / HMO POS, PPO)", "methodology": "case rate", "standard_charge_dollar": 1457.46 }, { "payer_name": "Wellchoice", "plan_name": "WELLCHOICE HMO of NJ (Empire) Commercial (Indemnity)", "methodology": "case rate", "standard_charge_dollar": 1457.46 }, { "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup Medicare", "methodology": "fee schedule", "standard_charge_dollar": 480.58, "additional_payer_notes": "100.00% of Medicare Rates" } ] } ] }, { "description": "ALLOGENEIC BONE MARROW TRANSPLANT- SOI : 4", "code_information": [ { "code": "0074", "type": "APR-DRG" } ], "standard_charges": [ { "setting": "inpatient", "minimum": 193065.77, "maximum": 212372.35, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Better Health - Medi Medi", "methodology": "case rate", "standard_charge_dollar": 212372.35, "additional_payer_notes": "110% of State Medicaid Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Better Health Medicaid", "methodology": "case rate", "standard_charge_dollar": 212372.35, "additional_payer_notes": "110% of State Medicaid Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "case rate", "standard_charge_dollar": 193065.77, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "UBH", "plan_name": "UBH Medicaid", "methodology": "case rate", "standard_charge_dollar": 193065.77, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicaid (02/01/2023 to 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 196927.09, "additional_payer_notes": "102% of State Medicaid Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicaid", "methodology": "case rate", "standard_charge_dollar": 193065.77, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup Medicaid", "methodology": "case rate", "standard_charge_dollar": 193065.77, "additional_payer_notes": "100% of State Medicaid Rates" } ] } ] }, { "description": "Hc Detect Agent,Immun,Dir Obs, Rsv", "code_information": [ { "code": "87807", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 24.0, "discounted_cash": 13.0, "minimum": 4.5816, "maximum": 24.0, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 24.0, "additional_payer_notes": "212.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medical Rental Network", "methodology": "fee schedule", "standard_charge_dollar": 24.0, "additional_payer_notes": "212.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 13.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "ALLY-ALIGN (FKA SPARTAN PLAN NJ, INC.)", "plan_name": "ALLY-ALIGN (FKA SPARTAN PLAN NJ, INC.)", "methodology": "fee schedule", "standard_charge_dollar": 13.76, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Americhoice (UHC)", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 13.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Amerihealth", "plan_name": "Amerihealth Medicare", "methodology": "fee schedule", "standard_charge_dollar": 13.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 19.0, "additional_payer_notes": "Laboratory - 145.00% of Medicare Rates" }, { "payer_name": "Clover Health", "plan_name": "Clover Medicare", "methodology": "fee schedule", "standard_charge_dollar": 13.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Coventry", "plan_name": "Coventry Auto", "methodology": "fee schedule", "standard_charge_dollar": 24.0, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Coventry", "plan_name": "Coventry Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 24.0, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "fee schedule", "standard_charge_dollar": 18.34, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Fairprice Healthcare Holdings", "plan_name": "Fairprice Healthcare Holdings", "methodology": "fee schedule", "standard_charge_dollar": 15.72, "additional_payer_notes": "Laboratory - 120.00% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ HMO POS", "methodology": "fee schedule", "standard_charge_dollar": 16.94, "additional_payer_notes": "177.30% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ Indemnity", "methodology": "fee schedule", "standard_charge_dollar": 16.94, "additional_payer_notes": "177.30% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ PPO", "methodology": "fee schedule", "standard_charge_dollar": 16.94, "additional_payer_notes": "177.30% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon Medicare", "methodology": "fee schedule", "standard_charge_dollar": 13.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Military Tricare", "methodology": "fee schedule", "standard_charge_dollar": 10.48, "additional_payer_notes": "80.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 13.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 13.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC All Payer (02-01-2023 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 7.86 }, { "payer_name": "UHC", "plan_name": "UHC Medicaid (02/01/2023 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 10.48 }, { "payer_name": "UHC", "plan_name": "UHC Oxford (02-01-2023 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 7.86 }, { "payer_name": "UHC - Adhoc", "plan_name": "UHC - Adhoc All Payer", "methodology": "fee schedule", "standard_charge_dollar": 13.1 }, { "payer_name": "UHC - Adhoc", "plan_name": "UHC - Adhoc Oxford", "methodology": "fee schedule", "standard_charge_dollar": 13.1 }, { "payer_name": "Wellcare", "plan_name": "Wellcare Insurance Exchange", "methodology": "fee schedule", "standard_charge_dollar": 17.69, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 13.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup Medicare", "methodology": "fee schedule", "standard_charge_dollar": 13.1, "additional_payer_notes": "100.00% of Medicare Rates" } ] } ] }, { "description": "Hc Venogram Super Vena Cava", "code_information": [ { "code": "75827", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 6574.78, "discounted_cash": 1860.0, "minimum": 1255.1255, "maximum": 5588.563, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 3945.26, "additional_payer_notes": "212.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medical Rental Network", "methodology": "fee schedule", "standard_charge_dollar": 3945.26, "additional_payer_notes": "212.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1860.97, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "ALLY-ALIGN (FKA SPARTAN PLAN NJ, INC.)", "plan_name": "ALLY-ALIGN (FKA SPARTAN PLAN NJ, INC.)", "methodology": "fee schedule", "standard_charge_dollar": 1954.02, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Americhoice (UHC)", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1860.97, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Amerihealth", "plan_name": "Amerihealth Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1860.97, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 2734.7, "additional_payer_notes": "146.95% of Medicare Rates" }, { "payer_name": "Clover Health", "plan_name": "Clover Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1860.97, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Coventry", "plan_name": "Coventry Auto", "methodology": "fee schedule", "standard_charge_dollar": 3721.94, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Coventry", "plan_name": "Coventry Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 3721.94, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "fee schedule", "standard_charge_dollar": 2605.36, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Fairprice Healthcare Holdings", "plan_name": "Fairprice Healthcare Holdings", "methodology": "fee schedule", "standard_charge_dollar": 2977.55, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ HMO POS", "methodology": "fee schedule", "standard_charge_dollar": 3299.5, "additional_payer_notes": "177.30% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ Indemnity", "methodology": "fee schedule", "standard_charge_dollar": 3299.5, "additional_payer_notes": "177.30% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ PPO", "methodology": "fee schedule", "standard_charge_dollar": 3299.5, "additional_payer_notes": "177.30% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1860.97, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Military Tricare", "methodology": "fee schedule", "standard_charge_dollar": 1488.78, "additional_payer_notes": "80.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1860.97, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 1860.97, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC All Payer (02-01-2023 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 2109.21 }, { "payer_name": "UHC", "plan_name": "UHC Oxford (02-01-2023 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 2109.21 }, { "payer_name": "UHC - Adhoc", "plan_name": "UHC - Adhoc All Payer", "methodology": "fee schedule", "standard_charge_dollar": 1406.14 }, { "payer_name": "UHC - Adhoc", "plan_name": "UHC - Adhoc Oxford", "methodology": "fee schedule", "standard_charge_dollar": 1406.14 }, { "payer_name": "Wellcare", "plan_name": "Wellcare Insurance Exchange", "methodology": "fee schedule", "standard_charge_dollar": 2512.31, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1860.97, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1860.97, "additional_payer_notes": "100.00% of Medicare Rates" } ] } ] }, { "description": "Hc Place Cath Subsubselect Art,Abd/Pel", "code_information": [ { "code": "36247", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 1607.0, "minimum": 306.7763, "maximum": 1607.0, "payers_information": [ { "payer_name": "UHC", "plan_name": "UHC All Payer (02-01-2023 to 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 1607.0 }, { "payer_name": "UHC", "plan_name": "UHC Oxford (02-01-2023 to 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 1607.0 }, { "payer_name": "UHC - Adhoc", "plan_name": "UHC - Adhoc All Payer", "methodology": "case rate", "standard_charge_dollar": 1607.0 }, { "payer_name": "UHC - Adhoc", "plan_name": "UHC - Adhoc Oxford", "methodology": "case rate", "standard_charge_dollar": 1607.0 }, { "payer_name": "Wellchoice", "plan_name": "WELLCHOICE HMO of NJ (Empire) Commercial (HMO / HMO POS, PPO)", "methodology": "case rate", "standard_charge_dollar": 1607.0 }, { "payer_name": "Wellchoice", "plan_name": "WELLCHOICE HMO of NJ (Empire) Commercial (Indemnity)", "methodology": "case rate", "standard_charge_dollar": 1607.0 }, { "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup Medicaid", "methodology": "percent of total billed charges", "standard_charge_percentage": 19.09, "median_amount": 449.56, "10th_percentile": 449.56, "90th_percentile": 449.56, "count": "1 through 10" } ] } ] }, { "description": "REHABILITATION - SOI : 3", "code_information": [ { "code": "8603", "type": "APR-DRG" } ], "standard_charges": [ { "setting": "inpatient", "minimum": 18871.41, "maximum": 20758.55, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Better Health - Medi Medi", "methodology": "case rate", "standard_charge_dollar": 20758.55, "additional_payer_notes": "110% of State Medicaid Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Better Health Medicaid", "methodology": "case rate", "standard_charge_dollar": 20758.55, "additional_payer_notes": "110% of State Medicaid Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "case rate", "standard_charge_dollar": 18871.41, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "UBH", "plan_name": "UBH Medicaid", "methodology": "case rate", "standard_charge_dollar": 18871.41, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicaid (02/01/2023 to 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 19248.83, "additional_payer_notes": "102% of State Medicaid Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicaid", "methodology": "case rate", "standard_charge_dollar": 18871.41, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup Medicaid", "methodology": "case rate", "standard_charge_dollar": 18871.41, "additional_payer_notes": "100% of State Medicaid Rates" } ] } ] }, { "description": "NEONATE BWT 1500-2499G W MAJOR PROCEDURE - SOI : 1", "code_information": [ { "code": "6091", "type": "APR-DRG" } ], "standard_charges": [ { "setting": "inpatient", "minimum": 47422.09, "maximum": 52164.3, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Better Health - Medi Medi", "methodology": "case rate", "standard_charge_dollar": 52164.3, "additional_payer_notes": "110% of State Medicaid Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Better Health Medicaid", "methodology": "case rate", "standard_charge_dollar": 52164.3, "additional_payer_notes": "110% of State Medicaid Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "case rate", "standard_charge_dollar": 47422.09, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "UBH", "plan_name": "UBH Medicaid", "methodology": "case rate", "standard_charge_dollar": 47422.09, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicaid (02/01/2023 to 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 48370.54, "additional_payer_notes": "102% of State Medicaid Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicaid", "methodology": "case rate", "standard_charge_dollar": 47422.09, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup Medicaid", "methodology": "case rate", "standard_charge_dollar": 47422.09, "additional_payer_notes": "100% of State Medicaid Rates" } ] } ] }, { "description": "Hc Mri Brain Combo", "code_information": [ { "code": "70553", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 5116.57, "discounted_cash": 412.0, "minimum": 329.952, "maximum": 4349.0845, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 874.37, "additional_payer_notes": "212.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medical Rental Network", "methodology": "fee schedule", "standard_charge_dollar": 874.37, "additional_payer_notes": "212.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 412.44, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "ALLY-ALIGN (FKA SPARTAN PLAN NJ, INC.)", "plan_name": "ALLY-ALIGN (FKA SPARTAN PLAN NJ, INC.)", "methodology": "fee schedule", "standard_charge_dollar": 433.06, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Americhoice (UHC)", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 412.44, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Amerihealth", "plan_name": "Amerihealth HMO", "methodology": "fee schedule", "standard_charge_dollar": 1241.24 }, { "payer_name": "Amerihealth", "plan_name": "Amerihealth Medicare", "methodology": "fee schedule", "standard_charge_dollar": 412.44, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 606.08, "additional_payer_notes": "146.95% of Medicare Rates" }, { "payer_name": "Clover Health", "plan_name": "Clover Medicare", "methodology": "fee schedule", "standard_charge_dollar": 412.44, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Coventry", "plan_name": "Coventry Auto", "methodology": "fee schedule", "standard_charge_dollar": 824.88, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Coventry", "plan_name": "Coventry Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 824.88, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "fee schedule", "standard_charge_dollar": 577.42, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Fairprice Healthcare Holdings", "plan_name": "Fairprice Healthcare Holdings", "methodology": "fee schedule", "standard_charge_dollar": 659.9, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ HMO POS", "methodology": "fee schedule", "standard_charge_dollar": 731.26, "additional_payer_notes": "177.30% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ Indemnity", "methodology": "fee schedule", "standard_charge_dollar": 731.26, "additional_payer_notes": "177.30% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ PPO", "methodology": "fee schedule", "standard_charge_dollar": 731.26, "additional_payer_notes": "177.30% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon Medicare", "methodology": "fee schedule", "standard_charge_dollar": 412.44, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon NJ Health Medicaid", "methodology": "percent of total billed charges", "standard_charge_percentage": 19.58, "median_amount": 1001.82, "10th_percentile": 420.58, "90th_percentile": 1001.82, "count": "1 through 10" }, { "payer_name": "Humana", "plan_name": "Humana Military Tricare", "methodology": "fee schedule", "standard_charge_dollar": 329.95, "additional_payer_notes": "80.00% of Medicare Rates" }, { "payer_name": "Keenan", "plan_name": "Keenan", "methodology": "percent of total billed charges", "standard_charge_percentage": 30.0, "median_amount": 1534.97, "10th_percentile": 1534.97, "90th_percentile": 2616.19, "count": "1 through 10" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 412.44, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 412.44, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC All Payer (02-01-2023 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 552.18 }, { "payer_name": "UHC", "plan_name": "UHC Medicaid (02/01/2023 to 12-31-2026)", "methodology": "percent of total billed charges", "standard_charge_percentage": 19.47, "median_amount": 973.32, "10th_percentile": 973.32, "90th_percentile": 996.29, "count": "1 through 10" }, { "payer_name": "UHC", "plan_name": "UHC Oxford (02-01-2023 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 552.18 }, { "payer_name": "UHC - Adhoc", "plan_name": "UHC - Adhoc All Payer", "methodology": "fee schedule", "standard_charge_dollar": 368.12 }, { "payer_name": "UHC - Adhoc", "plan_name": "UHC - Adhoc Oxford", "methodology": "fee schedule", "standard_charge_dollar": 368.12 }, { "payer_name": "Wellcare", "plan_name": "Wellcare Insurance Exchange", "methodology": "fee schedule", "standard_charge_dollar": 556.79, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 412.44, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup Medicare", "methodology": "fee schedule", "standard_charge_dollar": 412.44, "additional_payer_notes": "100.00% of Medicare Rates" } ] } ] }, { "description": "FOOT PROCEDURES WITH MCC", "code_information": [ { "code": "503", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 33811.0, "minimum": 15999.23, "maximum": 61199.6838, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "case rate", "standard_charge_dollar": 61199.68, "additional_payer_notes": "181.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medical Rental Network", "methodology": "case rate", "standard_charge_dollar": 61199.68, "additional_payer_notes": "181.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "case rate", "standard_charge_dollar": 27456.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "ALLY-ALIGN (FKA SPARTAN PLAN NJ, INC.)", "plan_name": "ALLY-ALIGN (FKA SPARTAN PLAN NJ, INC.)", "methodology": "case rate", "standard_charge_dollar": 35502.58, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Americhoice (UHC)", "plan_name": "UHC Medicare", "methodology": "case rate", "standard_charge_dollar": 27456.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Amerihealth", "plan_name": "Amerihealth Medicare", "methodology": "case rate", "standard_charge_dollar": 27456.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Commercial", "methodology": "case rate", "standard_charge_dollar": 40833.79 }, { "payer_name": "Clover Health", "plan_name": "Clover Medicare", "methodology": "case rate", "standard_charge_dollar": 27456.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Coventry", "plan_name": "Coventry Auto", "methodology": "case rate", "standard_charge_dollar": 57480.37, "additional_payer_notes": "170.00% of Medicare Rates" }, { "payer_name": "Coventry", "plan_name": "Coventry Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 57480.37, "additional_payer_notes": "170.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "case rate", "standard_charge_dollar": 43955.57, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Fairprice Healthcare Holdings", "plan_name": "Fairprice Healthcare Holdings", "methodology": "case rate", "standard_charge_dollar": 54099.17, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon Medicare", "methodology": "case rate", "standard_charge_dollar": 27456.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon NJ Health Medicaid", "methodology": "case rate", "standard_charge_dollar": 15999.23 }, { "payer_name": "Humana", "plan_name": "Humana Military Tricare", "methodology": "case rate", "standard_charge_dollar": 27049.58, "additional_payer_notes": "80.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 33811.98, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 38504.8 }, { "payer_name": "UBH", "plan_name": "UBH Medicare", "methodology": "case rate", "standard_charge_dollar": 27456.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC All Payer (02-01-2023 to 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 47046.78 }, { "payer_name": "UHC", "plan_name": "UHC Oxford (02-01-2023 to 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 41001.26 }, { "payer_name": "UHC - Adhoc", "plan_name": "UHC - Adhoc All Payer", "methodology": "case rate", "standard_charge_dollar": 49941.15 }, { "payer_name": "UHC - Adhoc", "plan_name": "UHC - Adhoc Oxford", "methodology": "case rate", "standard_charge_dollar": 42251.67 }, { "payer_name": "Wellcare", "plan_name": "Wellcare Insurance Exchange", "methodology": "case rate", "standard_charge_dollar": 45646.17, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "case rate", "standard_charge_dollar": 27456.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup Medicare", "methodology": "case rate", "standard_charge_dollar": 27456.8, "additional_payer_notes": "100.00% of Medicare Rates" } ] } ] }, { "description": "CARDIAC VALVE PROCEDURES W AMI OR COMPLEX PDX - SOI : 1", "code_information": [ { "code": "1621", "type": "APR-DRG" } ], "standard_charges": [ { "setting": "inpatient", "minimum": 55157.61, "maximum": 60673.37, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Better Health - Medi Medi", "methodology": "case rate", "standard_charge_dollar": 60673.37, "additional_payer_notes": "110% of State Medicaid Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Better Health Medicaid", "methodology": "case rate", "standard_charge_dollar": 60673.37, "additional_payer_notes": "110% of State Medicaid Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "case rate", "standard_charge_dollar": 55157.61, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "UBH", "plan_name": "UBH Medicaid", "methodology": "case rate", "standard_charge_dollar": 55157.61, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicaid (02/01/2023 to 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 56260.77, "additional_payer_notes": "102% of State Medicaid Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicaid", "methodology": "case rate", "standard_charge_dollar": 55157.61, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup Medicaid", "methodology": "case rate", "standard_charge_dollar": 55157.61, "additional_payer_notes": "100% of State Medicaid Rates" } ] } ] }, { "description": "OSTEOMYELITIS, SEPTIC ARTHRITIS & OTHER MUSCULOSKELETAL INFECTIONS - SOI : 1", "code_information": [ { "code": "3441", "type": "APR-DRG" } ], "standard_charges": [ { "setting": "inpatient", "minimum": 8316.82, "maximum": 9148.5, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Better Health - Medi Medi", "methodology": "case rate", "standard_charge_dollar": 9148.5, "additional_payer_notes": "110% of State Medicaid Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Better Health Medicaid", "methodology": "case rate", "standard_charge_dollar": 9148.5, "additional_payer_notes": "110% of State Medicaid Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "case rate", "standard_charge_dollar": 8316.82, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "UBH", "plan_name": "UBH Medicaid", "methodology": "case rate", "standard_charge_dollar": 8316.82, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicaid (02/01/2023 to 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 8483.16, "additional_payer_notes": "102% of State Medicaid Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicaid", "methodology": "case rate", "standard_charge_dollar": 8316.82, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup Medicaid", "methodology": "case rate", "standard_charge_dollar": 8316.82, "additional_payer_notes": "100% of State Medicaid Rates" } ] } ] }, { "description": "VAGINAL DELIVERY W STERILIZATION &OR D&C - SOI : 1", "code_information": [ { "code": "5411", "type": "APR-DRG" } ], "standard_charges": [ { "setting": "inpatient", "minimum": 7725.16, "maximum": 8497.68, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Better Health - Medi Medi", "methodology": "case rate", "standard_charge_dollar": 8497.68, "additional_payer_notes": "110% of State Medicaid Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Better Health Medicaid", "methodology": "case rate", "standard_charge_dollar": 8497.68, "additional_payer_notes": "110% of State Medicaid Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "case rate", "standard_charge_dollar": 7725.16, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "UBH", "plan_name": "UBH Medicaid", "methodology": "case rate", "standard_charge_dollar": 7725.16, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicaid (02/01/2023 to 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 7879.66, "additional_payer_notes": "102% of State Medicaid Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicaid", "methodology": "case rate", "standard_charge_dollar": 7725.16, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup Medicaid", "methodology": "case rate", "standard_charge_dollar": 7725.16, "additional_payer_notes": "100% of State Medicaid Rates" } ] } ] }, { "description": "Adjmt/Revj Ext Fixj Sys Anes", "code_information": [ { "code": "20693", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 38952.0, "discounted_cash": 8578.0, "minimum": 1446.0675, "maximum": 31161.6, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 18186.06, "additional_payer_notes": "212.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medical Rental Network", "methodology": "fee schedule", "standard_charge_dollar": 18186.06, "additional_payer_notes": "212.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 8578.33, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "ALLY-ALIGN (FKA SPARTAN PLAN NJ, INC.)", "plan_name": "ALLY-ALIGN (FKA SPARTAN PLAN NJ, INC.)", "methodology": "fee schedule", "standard_charge_dollar": 9007.25, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Americhoice (UHC)", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 8578.33, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Amerihealth", "plan_name": "Amerihealth Medicare", "methodology": "fee schedule", "standard_charge_dollar": 8578.33, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 12605.86, "additional_payer_notes": "146.95% of Medicare Rates" }, { "payer_name": "Clover Health", "plan_name": "Clover Medicare", "methodology": "fee schedule", "standard_charge_dollar": 8578.33, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Coventry", "plan_name": "Coventry Auto", "methodology": "fee schedule", "standard_charge_dollar": 17156.66, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Coventry", "plan_name": "Coventry Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 17156.66, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "fee schedule", "standard_charge_dollar": 12009.66, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Fairprice Healthcare Holdings", "plan_name": "Fairprice Healthcare Holdings", "methodology": "fee schedule", "standard_charge_dollar": 13725.33, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ HMO POS", "methodology": "fee schedule", "standard_charge_dollar": 15209.38, "additional_payer_notes": "177.30% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ Indemnity", "methodology": "fee schedule", "standard_charge_dollar": 15209.38, "additional_payer_notes": "177.30% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ PPO", "methodology": "fee schedule", "standard_charge_dollar": 15209.38, "additional_payer_notes": "177.30% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon Medicare", "methodology": "fee schedule", "standard_charge_dollar": 8578.33, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Military Tricare", "methodology": "fee schedule", "standard_charge_dollar": 6862.66, "additional_payer_notes": "80.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 8578.33, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 8578.33, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC All Payer (02-01-2023 to 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 5378.0 }, { "payer_name": "UHC", "plan_name": "UHC Oxford (02-01-2023 to 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 5169.0 }, { "payer_name": "UHC - Adhoc", "plan_name": "UHC - Adhoc All Payer", "methodology": "case rate", "standard_charge_dollar": 5709.0 }, { "payer_name": "UHC - Adhoc", "plan_name": "UHC - Adhoc Oxford", "methodology": "case rate", "standard_charge_dollar": 5327.0 }, { "payer_name": "Wellcare", "plan_name": "Wellcare Insurance Exchange", "methodology": "fee schedule", "standard_charge_dollar": 11580.75, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 8578.33, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellchoice", "plan_name": "WELLCHOICE HMO of NJ (Empire) Commercial (HMO / HMO POS, PPO)", "methodology": "case rate", "standard_charge_dollar": 1715.0 }, { "payer_name": "Wellchoice", "plan_name": "WELLCHOICE HMO of NJ (Empire) Commercial (Indemnity)", "methodology": "case rate", "standard_charge_dollar": 1978.0 }, { "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup Medicare", "methodology": "fee schedule", "standard_charge_dollar": 8578.33, "additional_payer_notes": "100.00% of Medicare Rates" } ] } ] }, { "description": "Hc Ercp W/Pressure Measurement Sphincter Of Oddi", "code_information": [ { "code": "43263", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 15404.0, "discounted_cash": 2268.0, "minimum": 1814.832, "maximum": 13093.4, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 4809.3, "additional_payer_notes": "212.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medical Rental Network", "methodology": "fee schedule", "standard_charge_dollar": 4809.3, "additional_payer_notes": "212.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2268.54, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "ALLY-ALIGN (FKA SPARTAN PLAN NJ, INC.)", "plan_name": "ALLY-ALIGN (FKA SPARTAN PLAN NJ, INC.)", "methodology": "fee schedule", "standard_charge_dollar": 2381.97, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Americhoice (UHC)", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2268.54, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Amerihealth", "plan_name": "Amerihealth Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2268.54, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 3333.62, "additional_payer_notes": "146.95% of Medicare Rates" }, { "payer_name": "Clover Health", "plan_name": "Clover Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2268.54, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Coventry", "plan_name": "Coventry Auto", "methodology": "fee schedule", "standard_charge_dollar": 4537.08, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Coventry", "plan_name": "Coventry Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 4537.08, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "fee schedule", "standard_charge_dollar": 3175.96, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Fairprice Healthcare Holdings", "plan_name": "Fairprice Healthcare Holdings", "methodology": "fee schedule", "standard_charge_dollar": 3629.66, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ HMO POS", "methodology": "fee schedule", "standard_charge_dollar": 4022.12, "additional_payer_notes": "177.30% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ Indemnity", "methodology": "fee schedule", "standard_charge_dollar": 4022.12, "additional_payer_notes": "177.30% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ PPO", "methodology": "fee schedule", "standard_charge_dollar": 4022.12, "additional_payer_notes": "177.30% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2268.54, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Military Tricare", "methodology": "fee schedule", "standard_charge_dollar": 1814.83, "additional_payer_notes": "80.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2268.54, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 2268.54, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC All Payer (02-01-2023 to 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 4415.0 }, { "payer_name": "UHC", "plan_name": "UHC Oxford (02-01-2023 to 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 4020.0 }, { "payer_name": "UHC - Adhoc", "plan_name": "UHC - Adhoc All Payer", "methodology": "case rate", "standard_charge_dollar": 4687.0 }, { "payer_name": "UHC - Adhoc", "plan_name": "UHC - Adhoc Oxford", "methodology": "case rate", "standard_charge_dollar": 4143.0 }, { "payer_name": "Wellcare", "plan_name": "Wellcare Insurance Exchange", "methodology": "fee schedule", "standard_charge_dollar": 3062.53, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2268.54, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2268.54, "additional_payer_notes": "100.00% of Medicare Rates" } ] } ] }, { "description": "UNCOMPLICATED PEPTIC ULCER WITH MCC", "code_information": [ { "code": "383", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 17512.0, "minimum": 8436.1, "maximum": 31698.0594, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "case rate", "standard_charge_dollar": 31698.06, "additional_payer_notes": "181.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medical Rental Network", "methodology": "case rate", "standard_charge_dollar": 31698.06, "additional_payer_notes": "181.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "case rate", "standard_charge_dollar": 14369.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "ALLY-ALIGN (FKA SPARTAN PLAN NJ, INC.)", "plan_name": "ALLY-ALIGN (FKA SPARTAN PLAN NJ, INC.)", "methodology": "case rate", "standard_charge_dollar": 18388.38, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Americhoice (UHC)", "plan_name": "UHC Medicare", "methodology": "case rate", "standard_charge_dollar": 14369.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Amerihealth", "plan_name": "Amerihealth Medicare", "methodology": "case rate", "standard_charge_dollar": 14369.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Commercial", "methodology": "case rate", "standard_charge_dollar": 20199.64 }, { "payer_name": "Clover Health", "plan_name": "Clover Medicare", "methodology": "case rate", "standard_charge_dollar": 14369.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Coventry", "plan_name": "Coventry Auto", "methodology": "case rate", "standard_charge_dollar": 29771.66, "additional_payer_notes": "170.00% of Medicare Rates" }, { "payer_name": "Coventry", "plan_name": "Coventry Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 29771.66, "additional_payer_notes": "170.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "case rate", "standard_charge_dollar": 22766.56, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Fairprice Healthcare Holdings", "plan_name": "Fairprice Healthcare Holdings", "methodology": "case rate", "standard_charge_dollar": 28020.38, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon Medicare", "methodology": "case rate", "standard_charge_dollar": 14369.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon NJ Health Medicaid", "methodology": "case rate", "standard_charge_dollar": 8436.1 }, { "payer_name": "Humana", "plan_name": "Humana Military Tricare", "methodology": "case rate", "standard_charge_dollar": 14010.19, "additional_payer_notes": "80.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 17512.74, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 18393.2 }, { "payer_name": "UBH", "plan_name": "UBH Medicare", "methodology": "case rate", "standard_charge_dollar": 14369.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC All Payer (02-01-2023 to 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 23273.08 }, { "payer_name": "UHC", "plan_name": "UHC Oxford (02-01-2023 to 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 20282.48 }, { "payer_name": "UHC - Adhoc", "plan_name": "UHC - Adhoc All Payer", "methodology": "case rate", "standard_charge_dollar": 24704.87 }, { "payer_name": "UHC - Adhoc", "plan_name": "UHC - Adhoc Oxford", "methodology": "case rate", "standard_charge_dollar": 20901.04 }, { "payer_name": "Wellcare", "plan_name": "Wellcare Insurance Exchange", "methodology": "case rate", "standard_charge_dollar": 23642.2, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "case rate", "standard_charge_dollar": 14369.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup Medicare", "methodology": "case rate", "standard_charge_dollar": 14369.0, "additional_payer_notes": "100.00% of Medicare Rates" } ] } ] }, { "description": "OTHER INJURY, POISONING & TOXIC EFFECT DIAGNOSES - SOI : 1", "code_information": [ { "code": "8151", "type": "APR-DRG" } ], "standard_charges": [ { "setting": "inpatient", "minimum": 4848.03, "maximum": 5332.83, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Better Health - Medi Medi", "methodology": "case rate", "standard_charge_dollar": 5332.83, "additional_payer_notes": "110% of State Medicaid Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Better Health Medicaid", "methodology": "case rate", "standard_charge_dollar": 5332.83, "additional_payer_notes": "110% of State Medicaid Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "case rate", "standard_charge_dollar": 4848.03, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "UBH", "plan_name": "UBH Medicaid", "methodology": "case rate", "standard_charge_dollar": 4848.03, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicaid (02/01/2023 to 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 4944.99, "additional_payer_notes": "102% of State Medicaid Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicaid", "methodology": "case rate", "standard_charge_dollar": 4848.03, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup Medicaid", "methodology": "case rate", "standard_charge_dollar": 4848.03, "additional_payer_notes": "100% of State Medicaid Rates" } ] } ] }, { "description": "Hc Egd Ablate Tumor Polyp/Lesion W/Dilation& Wire", "code_information": [ { "code": "43270", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 7811.63, "discounted_cash": 2268.0, "minimum": 1491.2402, "maximum": 6639.8855, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 4809.3, "additional_payer_notes": "212.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medical Rental Network", "methodology": "fee schedule", "standard_charge_dollar": 4809.3, "additional_payer_notes": "212.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2268.54, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "ALLY-ALIGN (FKA SPARTAN PLAN NJ, INC.)", "plan_name": "ALLY-ALIGN (FKA SPARTAN PLAN NJ, INC.)", "methodology": "fee schedule", "standard_charge_dollar": 2381.97, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Americhoice (UHC)", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2268.54, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Amerihealth", "plan_name": "Amerihealth Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2268.54, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 3333.62, "additional_payer_notes": "146.95% of Medicare Rates" }, { "payer_name": "Clover Health", "plan_name": "Clover Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2268.54, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Coventry", "plan_name": "Coventry Auto", "methodology": "fee schedule", "standard_charge_dollar": 4537.08, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Coventry", "plan_name": "Coventry Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 4537.08, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "fee schedule", "standard_charge_dollar": 3175.96, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Fairprice Healthcare Holdings", "plan_name": "Fairprice Healthcare Holdings", "methodology": "fee schedule", "standard_charge_dollar": 3629.66, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ HMO POS", "methodology": "fee schedule", "standard_charge_dollar": 4022.12, "additional_payer_notes": "177.30% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ Indemnity", "methodology": "fee schedule", "standard_charge_dollar": 4022.12, "additional_payer_notes": "177.30% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ PPO", "methodology": "fee schedule", "standard_charge_dollar": 4022.12, "additional_payer_notes": "177.30% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2268.54, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Military Tricare", "methodology": "fee schedule", "standard_charge_dollar": 1814.83, "additional_payer_notes": "80.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2268.54, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 2268.54, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC All Payer (02-01-2023 to 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 3912.0 }, { "payer_name": "UHC", "plan_name": "UHC Oxford (02-01-2023 to 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 3676.0 }, { "payer_name": "UHC - Adhoc", "plan_name": "UHC - Adhoc All Payer", "methodology": "case rate", "standard_charge_dollar": 4153.0 }, { "payer_name": "UHC - Adhoc", "plan_name": "UHC - Adhoc Oxford", "methodology": "case rate", "standard_charge_dollar": 3788.0 }, { "payer_name": "Wellcare", "plan_name": "Wellcare Insurance Exchange", "methodology": "fee schedule", "standard_charge_dollar": 3062.53, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2268.54, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2268.54, "additional_payer_notes": "100.00% of Medicare Rates" } ] } ] }, { "description": "RESPIRATORY MALIGNANCY - SOI : 2", "code_information": [ { "code": "1362", "type": "APR-DRG" } ], "standard_charges": [ { "setting": "inpatient", "minimum": 10573.89, "maximum": 11631.28, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Better Health - Medi Medi", "methodology": "case rate", "standard_charge_dollar": 11631.28, "additional_payer_notes": "110% of State Medicaid Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Better Health Medicaid", "methodology": "case rate", "standard_charge_dollar": 11631.28, "additional_payer_notes": "110% of State Medicaid Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "case rate", "standard_charge_dollar": 10573.89, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "UBH", "plan_name": "UBH Medicaid", "methodology": "case rate", "standard_charge_dollar": 10573.89, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicaid (02/01/2023 to 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 10785.37, "additional_payer_notes": "102% of State Medicaid Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicaid", "methodology": "case rate", "standard_charge_dollar": 10573.89, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup Medicaid", "methodology": "case rate", "standard_charge_dollar": 10573.89, "additional_payer_notes": "100% of State Medicaid Rates" } ] } ] }, { "description": "CORONARY BYPASS W AMI OR COMPLEX PDX - SOI : 4", "code_information": [ { "code": "1654", "type": "APR-DRG" } ], "standard_charges": [ { "setting": "inpatient", "minimum": 94068.25, "maximum": 103475.07, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Better Health - Medi Medi", "methodology": "case rate", "standard_charge_dollar": 103475.07, "additional_payer_notes": "110% of State Medicaid Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Better Health Medicaid", "methodology": "case rate", "standard_charge_dollar": 103475.07, "additional_payer_notes": "110% of State Medicaid Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "case rate", "standard_charge_dollar": 94068.25, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "UBH", "plan_name": "UBH Medicaid", "methodology": "case rate", "standard_charge_dollar": 94068.25, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicaid (02/01/2023 to 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 95949.61, "additional_payer_notes": "102% of State Medicaid Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicaid", "methodology": "case rate", "standard_charge_dollar": 94068.25, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup Medicaid", "methodology": "case rate", "standard_charge_dollar": 94068.25, "additional_payer_notes": "100% of State Medicaid Rates" } ] } ] }, { "description": "Hc Cmv Antibody", "code_information": [ { "code": "86644", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 163.9, "discounted_cash": 14.0, "minimum": 8.63, "maximum": 139.315, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 30.51, "additional_payer_notes": "212.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medical Rental Network", "methodology": "fee schedule", "standard_charge_dollar": 30.51, "additional_payer_notes": "212.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 14.39, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "ALLY-ALIGN (FKA SPARTAN PLAN NJ, INC.)", "plan_name": "ALLY-ALIGN (FKA SPARTAN PLAN NJ, INC.)", "methodology": "fee schedule", "standard_charge_dollar": 15.11, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Americhoice (UHC)", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 14.39, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Amerihealth", "plan_name": "Amerihealth Medicare", "methodology": "fee schedule", "standard_charge_dollar": 14.39, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 20.87, "additional_payer_notes": "Laboratory - 145.00% of Medicare Rates" }, { "payer_name": "Clover Health", "plan_name": "Clover Medicare", "methodology": "fee schedule", "standard_charge_dollar": 14.39, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Coventry", "plan_name": "Coventry Auto", "methodology": "fee schedule", "standard_charge_dollar": 28.78, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Coventry", "plan_name": "Coventry Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 28.78, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "fee schedule", "standard_charge_dollar": 20.15, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Fairprice Healthcare Holdings", "plan_name": "Fairprice Healthcare Holdings", "methodology": "fee schedule", "standard_charge_dollar": 17.27, "additional_payer_notes": "Laboratory - 120.00% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ HMO POS", "methodology": "fee schedule", "standard_charge_dollar": 115.71, "additional_payer_notes": "177.30% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ Indemnity", "methodology": "fee schedule", "standard_charge_dollar": 115.71, "additional_payer_notes": "177.30% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ PPO", "methodology": "fee schedule", "standard_charge_dollar": 115.71, "additional_payer_notes": "177.30% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon Medicare", "methodology": "fee schedule", "standard_charge_dollar": 14.39, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Military Tricare", "methodology": "fee schedule", "standard_charge_dollar": 11.51, "additional_payer_notes": "80.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 14.39, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 14.39, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC All Payer (02-01-2023 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 8.63 }, { "payer_name": "UHC", "plan_name": "UHC Medicaid (02/01/2023 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 11.51 }, { "payer_name": "UHC", "plan_name": "UHC Oxford (02-01-2023 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 8.63 }, { "payer_name": "UHC - Adhoc", "plan_name": "UHC - Adhoc All Payer", "methodology": "fee schedule", "standard_charge_dollar": 14.39 }, { "payer_name": "UHC - Adhoc", "plan_name": "UHC - Adhoc Oxford", "methodology": "fee schedule", "standard_charge_dollar": 14.39 }, { "payer_name": "Wellcare", "plan_name": "Wellcare Insurance Exchange", "methodology": "fee schedule", "standard_charge_dollar": 19.43, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 14.39, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup Medicare", "methodology": "fee schedule", "standard_charge_dollar": 14.39, "additional_payer_notes": "100.00% of Medicare Rates" } ] } ] }, { "description": "RESPIRATORY SIGNS AND SYMPTOMS", "code_information": [ { "code": "204", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 10887.0, "minimum": 4793.15, "maximum": 19706.2121, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "case rate", "standard_charge_dollar": 19706.21, "additional_payer_notes": "181.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medical Rental Network", "methodology": "case rate", "standard_charge_dollar": 19706.21, "additional_payer_notes": "181.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "case rate", "standard_charge_dollar": 9049.01, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "ALLY-ALIGN (FKA SPARTAN PLAN NJ, INC.)", "plan_name": "ALLY-ALIGN (FKA SPARTAN PLAN NJ, INC.)", "methodology": "case rate", "standard_charge_dollar": 11431.78, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Americhoice (UHC)", "plan_name": "UHC Medicare", "methodology": "case rate", "standard_charge_dollar": 9049.01, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Amerihealth", "plan_name": "Amerihealth Medicare", "methodology": "case rate", "standard_charge_dollar": 9049.01, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Commercial", "methodology": "case rate", "standard_charge_dollar": 11812.26 }, { "payer_name": "Clover Health", "plan_name": "Clover Medicare", "methodology": "case rate", "standard_charge_dollar": 9049.01, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Coventry", "plan_name": "Coventry Auto", "methodology": "case rate", "standard_charge_dollar": 18508.6, "additional_payer_notes": "170.00% of Medicare Rates" }, { "payer_name": "Coventry", "plan_name": "Coventry Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 18508.6, "additional_payer_notes": "170.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "case rate", "standard_charge_dollar": 14153.63, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Fairprice Healthcare Holdings", "plan_name": "Fairprice Healthcare Holdings", "methodology": "case rate", "standard_charge_dollar": 17419.86, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon Medicare", "methodology": "case rate", "standard_charge_dollar": 9049.01, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon NJ Health Medicaid", "methodology": "case rate", "standard_charge_dollar": 4793.15 }, { "payer_name": "Humana", "plan_name": "Humana Military Tricare", "methodology": "case rate", "standard_charge_dollar": 8709.93, "additional_payer_notes": "80.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 10887.41, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 7495.95 }, { "payer_name": "UBH", "plan_name": "UBH Medicare", "methodology": "case rate", "standard_charge_dollar": 9049.01, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC All Payer (02-01-2023 to 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 13609.53 }, { "payer_name": "UHC", "plan_name": "UHC Oxford (02-01-2023 to 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 11860.71 }, { "payer_name": "UHC - Adhoc", "plan_name": "UHC - Adhoc All Payer", "methodology": "case rate", "standard_charge_dollar": 14446.81 }, { "payer_name": "UHC - Adhoc", "plan_name": "UHC - Adhoc Oxford", "methodology": "case rate", "standard_charge_dollar": 12222.42 }, { "payer_name": "Wellcare", "plan_name": "Wellcare Insurance Exchange", "methodology": "case rate", "standard_charge_dollar": 14698.0, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "case rate", "standard_charge_dollar": 9049.01, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup Medicare", "methodology": "case rate", "standard_charge_dollar": 9049.01, "additional_payer_notes": "100.00% of Medicare Rates" } ] } ] }, { "description": "Hc Placement Ng/Og Tube By Physician", "code_information": [ { "code": "43752", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 1635.7, "discounted_cash": 528.0, "minimum": 312.2551, "maximum": 1635.7, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 1119.61, "additional_payer_notes": "212.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medical Rental Network", "methodology": "fee schedule", "standard_charge_dollar": 1119.61, "additional_payer_notes": "212.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 528.12, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "ALLY-ALIGN (FKA SPARTAN PLAN NJ, INC.)", "plan_name": "ALLY-ALIGN (FKA SPARTAN PLAN NJ, INC.)", "methodology": "fee schedule", "standard_charge_dollar": 554.53, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Americhoice (UHC)", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 528.12, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Amerihealth", "plan_name": "Amerihealth Medicare", "methodology": "fee schedule", "standard_charge_dollar": 528.12, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 776.07, "additional_payer_notes": "146.95% of Medicare Rates" }, { "payer_name": "Clover Health", "plan_name": "Clover Medicare", "methodology": "fee schedule", "standard_charge_dollar": 528.12, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Coventry", "plan_name": "Coventry Auto", "methodology": "fee schedule", "standard_charge_dollar": 1056.24, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Coventry", "plan_name": "Coventry Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 1056.24, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "fee schedule", "standard_charge_dollar": 739.37, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Fairprice Healthcare Holdings", "plan_name": "Fairprice Healthcare Holdings", "methodology": "fee schedule", "standard_charge_dollar": 844.99, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ HMO POS", "methodology": "fee schedule", "standard_charge_dollar": 936.36, "additional_payer_notes": "177.30% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ Indemnity", "methodology": "fee schedule", "standard_charge_dollar": 936.36, "additional_payer_notes": "177.30% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ PPO", "methodology": "fee schedule", "standard_charge_dollar": 936.36, "additional_payer_notes": "177.30% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon Medicare", "methodology": "fee schedule", "standard_charge_dollar": 528.12, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Military Tricare", "methodology": "fee schedule", "standard_charge_dollar": 422.5, "additional_payer_notes": "80.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 528.12, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 528.12, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC All Payer (02-01-2023 to 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 1635.7 }, { "payer_name": "UHC", "plan_name": "UHC Oxford (02-01-2023 to 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 1635.7 }, { "payer_name": "UHC - Adhoc", "plan_name": "UHC - Adhoc All Payer", "methodology": "case rate", "standard_charge_dollar": 1635.7 }, { "payer_name": "UHC - Adhoc", "plan_name": "UHC - Adhoc Oxford", "methodology": "case rate", "standard_charge_dollar": 1635.7 }, { "payer_name": "Wellcare", "plan_name": "Wellcare Insurance Exchange", "methodology": "fee schedule", "standard_charge_dollar": 712.96, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 528.12, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellchoice", "plan_name": "WELLCHOICE HMO of NJ (Empire) Commercial (HMO / HMO POS, PPO)", "methodology": "case rate", "standard_charge_dollar": 1635.7 }, { "payer_name": "Wellchoice", "plan_name": "WELLCHOICE HMO of NJ (Empire) Commercial (Indemnity)", "methodology": "case rate", "standard_charge_dollar": 1635.7 }, { "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup Medicare", "methodology": "fee schedule", "standard_charge_dollar": 528.12, "additional_payer_notes": "100.00% of Medicare Rates" } ] } ] }, { "description": "HYSTEROSCOPY LYSIS", "code_information": [ { "code": "58559", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 2885.63, "discounted_cash": 5913.0, "minimum": 550.8668, "maximum": 2885.63, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 2885.63, "additional_payer_notes": "212.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medical Rental Network", "methodology": "fee schedule", "standard_charge_dollar": 2885.63, "additional_payer_notes": "212.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2885.63, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "ALLY-ALIGN (FKA SPARTAN PLAN NJ, INC.)", "plan_name": "ALLY-ALIGN (FKA SPARTAN PLAN NJ, INC.)", "methodology": "fee schedule", "standard_charge_dollar": 2885.63, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Americhoice (UHC)", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2885.63, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Amerihealth", "plan_name": "Amerihealth Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2885.63, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 2885.63, "additional_payer_notes": "146.95% of Medicare Rates" }, { "payer_name": "Clover Health", "plan_name": "Clover Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2885.63, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Coventry", "plan_name": "Coventry Auto", "methodology": "fee schedule", "standard_charge_dollar": 2885.63, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Coventry", "plan_name": "Coventry Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 2885.63, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "fee schedule", "standard_charge_dollar": 2885.63, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Fairprice Healthcare Holdings", "plan_name": "Fairprice Healthcare Holdings", "methodology": "fee schedule", "standard_charge_dollar": 2885.63, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ HMO POS", "methodology": "fee schedule", "standard_charge_dollar": 2885.63, "additional_payer_notes": "177.30% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ Indemnity", "methodology": "fee schedule", "standard_charge_dollar": 2885.63, "additional_payer_notes": "177.30% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ PPO", "methodology": "fee schedule", "standard_charge_dollar": 2885.63, "additional_payer_notes": "177.30% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2885.63, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Military Tricare", "methodology": "fee schedule", "standard_charge_dollar": 2885.63, "additional_payer_notes": "80.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2885.63, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 2885.63, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC All Payer (02-01-2023 to 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 2885.63 }, { "payer_name": "UHC", "plan_name": "UHC Oxford (02-01-2023 to 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 2885.63 }, { "payer_name": "UHC - Adhoc", "plan_name": "UHC - Adhoc All Payer", "methodology": "case rate", "standard_charge_dollar": 2885.63 }, { "payer_name": "UHC - Adhoc", "plan_name": "UHC - Adhoc Oxford", "methodology": "case rate", "standard_charge_dollar": 2885.63 }, { "payer_name": "Wellcare", "plan_name": "Wellcare Insurance Exchange", "methodology": "fee schedule", "standard_charge_dollar": 2885.63, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2885.63, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellchoice", "plan_name": "WELLCHOICE HMO of NJ (Empire) Commercial (HMO / HMO POS, PPO)", "methodology": "case rate", "standard_charge_dollar": 1715.0 }, { "payer_name": "Wellchoice", "plan_name": "WELLCHOICE HMO of NJ (Empire) Commercial (Indemnity)", "methodology": "case rate", "standard_charge_dollar": 1978.0 }, { "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2885.63, "additional_payer_notes": "100.00% of Medicare Rates" } ] } ] }, { "description": "Hc Assay Of Sirolimus", "code_information": [ { "code": "80195", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 59.0, "discounted_cash": 13.0, "minimum": 8.24, "maximum": 50.15, "payers_information": [ { "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup Medicare", "methodology": "fee schedule", "standard_charge_dollar": 13.73, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 29.11, "additional_payer_notes": "212.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medical Rental Network", "methodology": "fee schedule", "standard_charge_dollar": 29.11, "additional_payer_notes": "212.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 13.73, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "ALLY-ALIGN (FKA SPARTAN PLAN NJ, INC.)", "plan_name": "ALLY-ALIGN (FKA SPARTAN PLAN NJ, INC.)", "methodology": "fee schedule", "standard_charge_dollar": 14.42, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Americhoice (UHC)", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 13.73, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Amerihealth", "plan_name": "Amerihealth Medicare", "methodology": "fee schedule", "standard_charge_dollar": 13.73, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 19.91, "additional_payer_notes": "Laboratory - 145.00% of Medicare Rates" }, { "payer_name": "Clover Health", "plan_name": "Clover Medicare", "methodology": "fee schedule", "standard_charge_dollar": 13.73, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Coventry", "plan_name": "Coventry Auto", "methodology": "fee schedule", "standard_charge_dollar": 27.46, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Coventry", "plan_name": "Coventry Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 27.46, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "fee schedule", "standard_charge_dollar": 19.22, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Fairprice Healthcare Holdings", "plan_name": "Fairprice Healthcare Holdings", "methodology": "fee schedule", "standard_charge_dollar": 16.48, "additional_payer_notes": "Laboratory - 120.00% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ HMO POS", "methodology": "fee schedule", "standard_charge_dollar": 41.65, "additional_payer_notes": "177.30% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ Indemnity", "methodology": "fee schedule", "standard_charge_dollar": 41.65, "additional_payer_notes": "177.30% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ PPO", "methodology": "fee schedule", "standard_charge_dollar": 41.65, "additional_payer_notes": "177.30% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon Medicare", "methodology": "fee schedule", "standard_charge_dollar": 13.73, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Military Tricare", "methodology": "fee schedule", "standard_charge_dollar": 10.98, "additional_payer_notes": "80.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 13.73, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 13.73, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC All Payer (02-01-2023 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 8.24 }, { "payer_name": "UHC", "plan_name": "UHC Medicaid (02/01/2023 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 10.98 }, { "payer_name": "UHC", "plan_name": "UHC Oxford (02-01-2023 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 8.24 }, { "payer_name": "UHC - Adhoc", "plan_name": "UHC - Adhoc All Payer", "methodology": "fee schedule", "standard_charge_dollar": 13.73 }, { "payer_name": "UHC - Adhoc", "plan_name": "UHC - Adhoc Oxford", "methodology": "fee schedule", "standard_charge_dollar": 13.73 }, { "payer_name": "Wellcare", "plan_name": "Wellcare Insurance Exchange", "methodology": "fee schedule", "standard_charge_dollar": 18.54, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 13.73, "additional_payer_notes": "100.00% of Medicare Rates" } ] } ] }, { "description": "Hc Office/Outpatient New High Mdm 60-74 Minutes - G0463 - 76100005", "code_information": [ { "code": "G0463", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 1331.0, "discounted_cash": 157.0, "minimum": 19.09, "maximum": 1131.35, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 333.67, "additional_payer_notes": "212.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medical Rental Network", "methodology": "fee schedule", "standard_charge_dollar": 333.67, "additional_payer_notes": "212.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 157.39, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "ALLY-ALIGN (FKA SPARTAN PLAN NJ, INC.)", "plan_name": "ALLY-ALIGN (FKA SPARTAN PLAN NJ, INC.)", "methodology": "fee schedule", "standard_charge_dollar": 165.26, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Americhoice (UHC)", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 157.39, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Amerihealth", "plan_name": "Amerihealth Medicare", "methodology": "fee schedule", "standard_charge_dollar": 157.39, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 231.28, "additional_payer_notes": "146.95% of Medicare Rates" }, { "payer_name": "Clover Health", "plan_name": "Clover Medicare", "methodology": "fee schedule", "standard_charge_dollar": 157.39, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Coventry", "plan_name": "Coventry Auto", "methodology": "fee schedule", "standard_charge_dollar": 314.78, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Coventry", "plan_name": "Coventry Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 314.78, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "fee schedule", "standard_charge_dollar": 220.35, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Fairprice Healthcare Holdings", "plan_name": "Fairprice Healthcare Holdings", "methodology": "fee schedule", "standard_charge_dollar": 251.82, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ HMO POS", "methodology": "fee schedule", "standard_charge_dollar": 279.05, "additional_payer_notes": "177.30% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ Indemnity", "methodology": "fee schedule", "standard_charge_dollar": 279.05, "additional_payer_notes": "177.30% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ PPO", "methodology": "fee schedule", "standard_charge_dollar": 279.05, "additional_payer_notes": "177.30% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon Medicare", "methodology": "fee schedule", "standard_charge_dollar": 157.39, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Military Tricare", "methodology": "fee schedule", "standard_charge_dollar": 125.91, "additional_payer_notes": "80.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 157.39, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 157.39, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Insurance Exchange", "methodology": "fee schedule", "standard_charge_dollar": 212.48, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 157.39, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup Medicare", "methodology": "fee schedule", "standard_charge_dollar": 157.39, "additional_payer_notes": "100.00% of Medicare Rates" } ] } ] }, { "description": "Hc Ro Teletherapy Isodode Plan, Simple", "code_information": [ { "code": "77306", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 820.5, "discounted_cash": 442.0, "minimum": 156.6335, "maximum": 820.5, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 820.5, "additional_payer_notes": "212.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medical Rental Network", "methodology": "fee schedule", "standard_charge_dollar": 820.5, "additional_payer_notes": "212.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 442.65, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "ALLY-ALIGN (FKA SPARTAN PLAN NJ, INC.)", "plan_name": "ALLY-ALIGN (FKA SPARTAN PLAN NJ, INC.)", "methodology": "fee schedule", "standard_charge_dollar": 464.78, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Americhoice (UHC)", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 442.65, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Amerihealth", "plan_name": "Amerihealth Medicare", "methodology": "fee schedule", "standard_charge_dollar": 442.65, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 650.47, "additional_payer_notes": "146.95% of Medicare Rates" }, { "payer_name": "Clover Health", "plan_name": "Clover Medicare", "methodology": "fee schedule", "standard_charge_dollar": 442.65, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Coventry", "plan_name": "Coventry Auto", "methodology": "fee schedule", "standard_charge_dollar": 820.5, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Coventry", "plan_name": "Coventry Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 820.5, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "fee schedule", "standard_charge_dollar": 619.71, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Fairprice Healthcare Holdings", "plan_name": "Fairprice Healthcare Holdings", "methodology": "fee schedule", "standard_charge_dollar": 708.24, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ HMO POS", "methodology": "fee schedule", "standard_charge_dollar": 784.82, "additional_payer_notes": "177.30% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ Indemnity", "methodology": "fee schedule", "standard_charge_dollar": 784.82, "additional_payer_notes": "177.30% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ PPO", "methodology": "fee schedule", "standard_charge_dollar": 784.82, "additional_payer_notes": "177.30% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon Medicare", "methodology": "fee schedule", "standard_charge_dollar": 442.65, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Military Tricare", "methodology": "fee schedule", "standard_charge_dollar": 354.12, "additional_payer_notes": "80.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 442.65, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 442.65, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC All Payer (02-01-2023 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 820.5 }, { "payer_name": "UHC", "plan_name": "UHC Oxford (02-01-2023 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 820.5 }, { "payer_name": "UHC - Adhoc", "plan_name": "UHC - Adhoc All Payer", "methodology": "fee schedule", "standard_charge_dollar": 820.5 }, { "payer_name": "UHC - Adhoc", "plan_name": "UHC - Adhoc Oxford", "methodology": "fee schedule", "standard_charge_dollar": 820.5 }, { "payer_name": "Wellcare", "plan_name": "Wellcare Insurance Exchange", "methodology": "fee schedule", "standard_charge_dollar": 597.58, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 442.65, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellchoice", "plan_name": "WELLCHOICE HMO of NJ (Empire) Commercial (HMO / HMO POS, PPO)", "methodology": "case rate", "standard_charge_dollar": 167.0 }, { "payer_name": "Wellchoice", "plan_name": "WELLCHOICE HMO of NJ (Empire) Commercial (Indemnity)", "methodology": "case rate", "standard_charge_dollar": 202.0 }, { "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup Medicare", "methodology": "fee schedule", "standard_charge_dollar": 442.65, "additional_payer_notes": "100.00% of Medicare Rates" } ] } ] }, { "description": "Hc Eval,Oral & Pharyngeal Swallow Function, 75 Min", "code_information": [ { "code": "92610", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 435.0, "discounted_cash": 62.0, "minimum": 50.232, "maximum": 432.0, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 133.11, "additional_payer_notes": "212.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medical Rental Network", "methodology": "fee schedule", "standard_charge_dollar": 133.11, "additional_payer_notes": "212.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 62.79, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "ALLY-ALIGN (FKA SPARTAN PLAN NJ, INC.)", "plan_name": "ALLY-ALIGN (FKA SPARTAN PLAN NJ, INC.)", "methodology": "fee schedule", "standard_charge_dollar": 65.93, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Americhoice (UHC)", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 62.79, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Amerihealth", "plan_name": "Amerihealth Medicare", "methodology": "fee schedule", "standard_charge_dollar": 62.79, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 158.0, "additional_payer_notes": "A Indicator - 155.00% of Medicare Rates" }, { "payer_name": "Clover Health", "plan_name": "Clover Medicare", "methodology": "fee schedule", "standard_charge_dollar": 62.79, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Coventry", "plan_name": "Coventry Auto", "methodology": "fee schedule", "standard_charge_dollar": 125.58, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Coventry", "plan_name": "Coventry Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 125.58, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "fee schedule", "standard_charge_dollar": 87.91, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Fairprice Healthcare Holdings", "plan_name": "Fairprice Healthcare Holdings", "methodology": "fee schedule", "standard_charge_dollar": 100.46 }, { "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ HMO POS", "methodology": "fee schedule", "standard_charge_dollar": 307.11, "additional_payer_notes": "177.30% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ Indemnity", "methodology": "fee schedule", "standard_charge_dollar": 307.11, "additional_payer_notes": "177.30% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ PPO", "methodology": "fee schedule", "standard_charge_dollar": 307.11, "additional_payer_notes": "177.30% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon Medicare", "methodology": "fee schedule", "standard_charge_dollar": 62.79, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon NJ Health Medicaid", "methodology": "percent of total billed charges", "standard_charge_percentage": 19.58, "median_amount": 93.09, "10th_percentile": 93.09, "90th_percentile": 94.17, "count": "1 through 10" }, { "payer_name": "Humana", "plan_name": "Humana Military Tricare", "methodology": "fee schedule", "standard_charge_dollar": 50.23, "additional_payer_notes": "80.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 62.79, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 62.79, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC All Payer (02-01-2023 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 407.0 }, { "payer_name": "UHC", "plan_name": "UHC Medicaid (02/01/2023 to 12-31-2026)", "methodology": "percent of total billed charges", "standard_charge_percentage": 19.47, "median_amount": 94.17, "10th_percentile": 93.09, "90th_percentile": 94.17, "count": "1 through 10" }, { "payer_name": "UHC", "plan_name": "UHC Oxford (02-01-2023 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 357.0 }, { "payer_name": "UHC - Adhoc", "plan_name": "UHC - Adhoc All Payer", "methodology": "fee schedule", "standard_charge_dollar": 432.0 }, { "payer_name": "UHC - Adhoc", "plan_name": "UHC - Adhoc Oxford", "methodology": "fee schedule", "standard_charge_dollar": 368.0 }, { "payer_name": "Wellcare", "plan_name": "Wellcare Insurance Exchange", "methodology": "fee schedule", "standard_charge_dollar": 84.77, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 62.79, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup Medicaid", "methodology": "percent of total billed charges", "standard_charge_percentage": 19.09, "median_amount": 81.13, "10th_percentile": 81.13, "90th_percentile": 93.09, "count": "1 through 10" }, { "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup Medicare", "methodology": "fee schedule", "standard_charge_dollar": 62.79, "additional_payer_notes": "100.00% of Medicare Rates" } ] } ] }, { "description": "Hc Antibiotic Sens,Enzyme Detection,Each", "code_information": [ { "code": "87185", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 23.75, "discounted_cash": 4.0, "minimum": 2.85, "maximum": 20.1875, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 10.07, "additional_payer_notes": "212.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medical Rental Network", "methodology": "fee schedule", "standard_charge_dollar": 10.07, "additional_payer_notes": "212.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 4.75, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "ALLY-ALIGN (FKA SPARTAN PLAN NJ, INC.)", "plan_name": "ALLY-ALIGN (FKA SPARTAN PLAN NJ, INC.)", "methodology": "fee schedule", "standard_charge_dollar": 4.99, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Americhoice (UHC)", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 4.75, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Amerihealth", "plan_name": "Amerihealth Medicare", "methodology": "fee schedule", "standard_charge_dollar": 4.75, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 6.89, "additional_payer_notes": "Laboratory - 145.00% of Medicare Rates" }, { "payer_name": "Clover Health", "plan_name": "Clover Medicare", "methodology": "fee schedule", "standard_charge_dollar": 4.75, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Coventry", "plan_name": "Coventry Auto", "methodology": "fee schedule", "standard_charge_dollar": 9.5, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Coventry", "plan_name": "Coventry Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 9.5, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "fee schedule", "standard_charge_dollar": 6.65, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Fairprice Healthcare Holdings", "plan_name": "Fairprice Healthcare Holdings", "methodology": "fee schedule", "standard_charge_dollar": 5.7, "additional_payer_notes": "Laboratory - 120.00% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ HMO POS", "methodology": "fee schedule", "standard_charge_dollar": 16.77, "additional_payer_notes": "177.30% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ Indemnity", "methodology": "fee schedule", "standard_charge_dollar": 16.77, "additional_payer_notes": "177.30% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ PPO", "methodology": "fee schedule", "standard_charge_dollar": 16.77, "additional_payer_notes": "177.30% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon Medicare", "methodology": "fee schedule", "standard_charge_dollar": 4.75, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Military Tricare", "methodology": "fee schedule", "standard_charge_dollar": 3.8, "additional_payer_notes": "80.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 4.75, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 4.75, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC All Payer (02-01-2023 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 2.85 }, { "payer_name": "UHC", "plan_name": "UHC Medicaid (02/01/2023 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 3.8 }, { "payer_name": "UHC", "plan_name": "UHC Oxford (02-01-2023 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 2.85 }, { "payer_name": "UHC - Adhoc", "plan_name": "UHC - Adhoc All Payer", "methodology": "fee schedule", "standard_charge_dollar": 4.75 }, { "payer_name": "UHC - Adhoc", "plan_name": "UHC - Adhoc Oxford", "methodology": "fee schedule", "standard_charge_dollar": 4.75 }, { "payer_name": "Wellcare", "plan_name": "Wellcare Insurance Exchange", "methodology": "fee schedule", "standard_charge_dollar": 6.41, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 4.75, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup Medicaid", "methodology": "percent of total billed charges", "standard_charge_percentage": 19.09, "median_amount": 4.43, "10th_percentile": 4.43, "90th_percentile": 4.43, "count": "1 through 10" }, { "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup Medicare", "methodology": "fee schedule", "standard_charge_dollar": 4.75, "additional_payer_notes": "100.00% of Medicare Rates" } ] } ] }, { "description": "HERNIA PROCEDURES EXCEPT INGUINAL, FEMORAL & UMBILICAL - SOI : 2", "code_information": [ { "code": "2272", "type": "APR-DRG" } ], "standard_charges": [ { "setting": "inpatient", "minimum": 17459.9, "maximum": 19205.89, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Better Health - Medi Medi", "methodology": "case rate", "standard_charge_dollar": 19205.89, "additional_payer_notes": "110% of State Medicaid Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Better Health Medicaid", "methodology": "case rate", "standard_charge_dollar": 19205.89, "additional_payer_notes": "110% of State Medicaid Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "case rate", "standard_charge_dollar": 17459.9, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "UBH", "plan_name": "UBH Medicaid", "methodology": "case rate", "standard_charge_dollar": 17459.9, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicaid (02/01/2023 to 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 17809.1, "additional_payer_notes": "102% of State Medicaid Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicaid", "methodology": "case rate", "standard_charge_dollar": 17459.9, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup Medicaid", "methodology": "case rate", "standard_charge_dollar": 17459.9, "additional_payer_notes": "100% of State Medicaid Rates" } ] } ] }, { "description": "REMOVAL OF BONE FOR GRAFT - 20900 - ", "code_information": [ { "code": "20900", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 17845.42, "discounted_cash": 8578.0, "minimum": 1715.0, "maximum": 17845.42, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 17845.42, "additional_payer_notes": "212.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medical Rental Network", "methodology": "fee schedule", "standard_charge_dollar": 17845.42, "additional_payer_notes": "212.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 8578.33, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "ALLY-ALIGN (FKA SPARTAN PLAN NJ, INC.)", "plan_name": "ALLY-ALIGN (FKA SPARTAN PLAN NJ, INC.)", "methodology": "fee schedule", "standard_charge_dollar": 9007.25, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Americhoice (UHC)", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 8578.33, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Amerihealth", "plan_name": "Amerihealth Medicare", "methodology": "fee schedule", "standard_charge_dollar": 8578.33, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 12605.86, "additional_payer_notes": "146.95% of Medicare Rates" }, { "payer_name": "Clover Health", "plan_name": "Clover Medicare", "methodology": "fee schedule", "standard_charge_dollar": 8578.33, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Coventry", "plan_name": "Coventry Auto", "methodology": "fee schedule", "standard_charge_dollar": 17156.66, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Coventry", "plan_name": "Coventry Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 17156.66, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "fee schedule", "standard_charge_dollar": 12009.66, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Fairprice Healthcare Holdings", "plan_name": "Fairprice Healthcare Holdings", "methodology": "fee schedule", "standard_charge_dollar": 13725.33, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ HMO POS", "methodology": "fee schedule", "standard_charge_dollar": 15209.38, "additional_payer_notes": "177.30% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ Indemnity", "methodology": "fee schedule", "standard_charge_dollar": 15209.38, "additional_payer_notes": "177.30% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ PPO", "methodology": "fee schedule", "standard_charge_dollar": 15209.38, "additional_payer_notes": "177.30% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon Medicare", "methodology": "fee schedule", "standard_charge_dollar": 8578.33, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Military Tricare", "methodology": "fee schedule", "standard_charge_dollar": 6862.66, "additional_payer_notes": "80.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 8578.33, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 8578.33, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC All Payer (02-01-2023 to 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 5378.0 }, { "payer_name": "UHC", "plan_name": "UHC Oxford (02-01-2023 to 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 5169.0 }, { "payer_name": "UHC - Adhoc", "plan_name": "UHC - Adhoc All Payer", "methodology": "case rate", "standard_charge_dollar": 5709.0 }, { "payer_name": "UHC - Adhoc", "plan_name": "UHC - Adhoc Oxford", "methodology": "case rate", "standard_charge_dollar": 5327.0 }, { "payer_name": "Wellcare", "plan_name": "Wellcare Insurance Exchange", "methodology": "fee schedule", "standard_charge_dollar": 11580.75, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 8578.33, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellchoice", "plan_name": "WELLCHOICE HMO of NJ (Empire) Commercial (HMO / HMO POS, PPO)", "methodology": "case rate", "standard_charge_dollar": 1715.0 }, { "payer_name": "Wellchoice", "plan_name": "WELLCHOICE HMO of NJ (Empire) Commercial (Indemnity)", "methodology": "case rate", "standard_charge_dollar": 1978.0 }, { "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup Medicare", "methodology": "fee schedule", "standard_charge_dollar": 8578.33, "additional_payer_notes": "100.00% of Medicare Rates" } ] } ] }, { "description": "OTITIS MEDIA AND URI WITHOUT MCC", "code_information": [ { "code": "153", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 10087.0, "minimum": 4444.72, "maximum": 18258.7551, "payers_information": [ { "payer_name": "Wellcare", "plan_name": "Wellcare Insurance Exchange", "methodology": "case rate", "standard_charge_dollar": 13618.41, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "case rate", "standard_charge_dollar": 8406.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup Medicare", "methodology": "case rate", "standard_charge_dollar": 8406.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "case rate", "standard_charge_dollar": 18258.76, "additional_payer_notes": "181.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medical Rental Network", "methodology": "case rate", "standard_charge_dollar": 18258.76, "additional_payer_notes": "181.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "case rate", "standard_charge_dollar": 8406.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "ALLY-ALIGN (FKA SPARTAN PLAN NJ, INC.)", "plan_name": "ALLY-ALIGN (FKA SPARTAN PLAN NJ, INC.)", "methodology": "case rate", "standard_charge_dollar": 10592.1, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Americhoice (UHC)", "plan_name": "UHC Medicare", "methodology": "case rate", "standard_charge_dollar": 8406.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Amerihealth", "plan_name": "Amerihealth Medicare", "methodology": "case rate", "standard_charge_dollar": 8406.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Commercial", "methodology": "case rate", "standard_charge_dollar": 10799.87 }, { "payer_name": "Clover Health", "plan_name": "Clover Medicare", "methodology": "case rate", "standard_charge_dollar": 8406.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Coventry", "plan_name": "Coventry Auto", "methodology": "case rate", "standard_charge_dollar": 17149.11, "additional_payer_notes": "170.00% of Medicare Rates" }, { "payer_name": "Coventry", "plan_name": "Coventry Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 17149.11, "additional_payer_notes": "170.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "case rate", "standard_charge_dollar": 13114.02, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Fairprice Healthcare Holdings", "plan_name": "Fairprice Healthcare Holdings", "methodology": "case rate", "standard_charge_dollar": 16140.34, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon Medicare", "methodology": "case rate", "standard_charge_dollar": 8406.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon NJ Health Medicaid", "methodology": "case rate", "standard_charge_dollar": 4444.72 }, { "payer_name": "Humana", "plan_name": "Humana Military Tricare", "methodology": "case rate", "standard_charge_dollar": 8070.17, "additional_payer_notes": "80.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 10087.71, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 6250.78 }, { "payer_name": "UBH", "plan_name": "UBH Medicare", "methodology": "case rate", "standard_charge_dollar": 8406.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC All Payer (02-01-2023 to 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 12443.1 }, { "payer_name": "UHC", "plan_name": "UHC Oxford (02-01-2023 to 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 10844.16 }, { "payer_name": "UHC - Adhoc", "plan_name": "UHC - Adhoc All Payer", "methodology": "case rate", "standard_charge_dollar": 13208.61 }, { "payer_name": "UHC - Adhoc", "plan_name": "UHC - Adhoc Oxford", "methodology": "case rate", "standard_charge_dollar": 11174.87 } ] } ] }, { "description": "NONSPECIFIC CVA & PRECEREBRAL OCCLUSION WO INFARCT - SOI : 1", "code_information": [ { "code": "0461", "type": "APR-DRG" } ], "standard_charges": [ { "setting": "inpatient", "minimum": 8278.13, "maximum": 9105.95, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Better Health - Medi Medi", "methodology": "case rate", "standard_charge_dollar": 9105.95, "additional_payer_notes": "110% of State Medicaid Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Better Health Medicaid", "methodology": "case rate", "standard_charge_dollar": 9105.95, "additional_payer_notes": "110% of State Medicaid Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "case rate", "standard_charge_dollar": 8278.13, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "UBH", "plan_name": "UBH Medicaid", "methodology": "case rate", "standard_charge_dollar": 8278.13, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicaid (02/01/2023 to 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 8443.7, "additional_payer_notes": "102% of State Medicaid Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicaid", "methodology": "case rate", "standard_charge_dollar": 8278.13, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup Medicaid", "methodology": "case rate", "standard_charge_dollar": 8278.13, "additional_payer_notes": "100% of State Medicaid Rates" } ] } ] }, { "description": "OTHER ANTEPARTUM DIAGNOSES WITH O.R. PROCEDURES WITHOUT CCMCC", "code_information": [ { "code": "819", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 11494.0, "minimum": 5239.0, "maximum": 20804.3753, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "case rate", "standard_charge_dollar": 20804.38, "additional_payer_notes": "181.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medical Rental Network", "methodology": "case rate", "standard_charge_dollar": 20804.38, "additional_payer_notes": "181.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "case rate", "standard_charge_dollar": 9536.19, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "ALLY-ALIGN (FKA SPARTAN PLAN NJ, INC.)", "plan_name": "ALLY-ALIGN (FKA SPARTAN PLAN NJ, INC.)", "methodology": "case rate", "standard_charge_dollar": 12068.84, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Americhoice (UHC)", "plan_name": "UHC Medicare", "methodology": "case rate", "standard_charge_dollar": 9536.19, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Amerihealth", "plan_name": "Amerihealth Medicare", "methodology": "case rate", "standard_charge_dollar": 9536.19, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Commercial", "methodology": "case rate", "standard_charge_dollar": 12580.34 }, { "payer_name": "Clover Health", "plan_name": "Clover Medicare", "methodology": "case rate", "standard_charge_dollar": 9536.19, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Coventry", "plan_name": "Coventry Auto", "methodology": "case rate", "standard_charge_dollar": 19540.02, "additional_payer_notes": "170.00% of Medicare Rates" }, { "payer_name": "Coventry", "plan_name": "Coventry Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 19540.02, "additional_payer_notes": "170.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "case rate", "standard_charge_dollar": 14942.37, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Fairprice Healthcare Holdings", "plan_name": "Fairprice Healthcare Holdings", "methodology": "case rate", "standard_charge_dollar": 18390.61, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon Medicare", "methodology": "case rate", "standard_charge_dollar": 9536.19, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon NJ Health Medicaid", "methodology": "case rate", "standard_charge_dollar": 5239.0 }, { "payer_name": "Humana", "plan_name": "Humana Military Tricare", "methodology": "case rate", "standard_charge_dollar": 9195.3, "additional_payer_notes": "80.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 11494.13, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 10884.1 }, { "payer_name": "UBH", "plan_name": "UBH Medicare", "methodology": "case rate", "standard_charge_dollar": 9536.19, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC All Payer (02-01-2023 to 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 14494.47 }, { "payer_name": "UHC", "plan_name": "UHC Oxford (02-01-2023 to 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 12631.93 }, { "payer_name": "UHC - Adhoc", "plan_name": "UHC - Adhoc All Payer", "methodology": "case rate", "standard_charge_dollar": 15386.19 }, { "payer_name": "UHC - Adhoc", "plan_name": "UHC - Adhoc Oxford", "methodology": "case rate", "standard_charge_dollar": 13017.17 }, { "payer_name": "Wellcare", "plan_name": "Wellcare Insurance Exchange", "methodology": "case rate", "standard_charge_dollar": 15517.08, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "case rate", "standard_charge_dollar": 9536.19, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup Medicare", "methodology": "case rate", "standard_charge_dollar": 9536.19, "additional_payer_notes": "100.00% of Medicare Rates" } ] } ] }, { "description": "Hc External Ecg Rec>7D<15D Recording", "code_information": [ { "code": "93246", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 278.3, "discounted_cash": 44.0, "minimum": 35.32, "maximum": 278.3, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 93.6, "additional_payer_notes": "212.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medical Rental Network", "methodology": "fee schedule", "standard_charge_dollar": 93.6, "additional_payer_notes": "212.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 44.15, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "ALLY-ALIGN (FKA SPARTAN PLAN NJ, INC.)", "plan_name": "ALLY-ALIGN (FKA SPARTAN PLAN NJ, INC.)", "methodology": "fee schedule", "standard_charge_dollar": 46.36, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Americhoice (UHC)", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 44.15, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Amerihealth", "plan_name": "Amerihealth Medicare", "methodology": "fee schedule", "standard_charge_dollar": 44.15, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 64.88, "additional_payer_notes": "146.95% of Medicare Rates" }, { "payer_name": "Clover Health", "plan_name": "Clover Medicare", "methodology": "fee schedule", "standard_charge_dollar": 44.15, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Coventry", "plan_name": "Coventry Auto", "methodology": "fee schedule", "standard_charge_dollar": 88.3, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Coventry", "plan_name": "Coventry Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 88.3, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "fee schedule", "standard_charge_dollar": 61.81, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Fairprice Healthcare Holdings", "plan_name": "Fairprice Healthcare Holdings", "methodology": "fee schedule", "standard_charge_dollar": 70.64, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ HMO POS", "methodology": "fee schedule", "standard_charge_dollar": 78.28, "additional_payer_notes": "177.30% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ Indemnity", "methodology": "fee schedule", "standard_charge_dollar": 78.28, "additional_payer_notes": "177.30% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ PPO", "methodology": "fee schedule", "standard_charge_dollar": 78.28, "additional_payer_notes": "177.30% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon Medicare", "methodology": "fee schedule", "standard_charge_dollar": 44.15, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Military Tricare", "methodology": "fee schedule", "standard_charge_dollar": 35.32, "additional_payer_notes": "80.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 44.15, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 44.15, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC All Payer (02-01-2023 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 278.3 }, { "payer_name": "UHC", "plan_name": "UHC Oxford (02-01-2023 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 278.3 }, { "payer_name": "UHC - Adhoc", "plan_name": "UHC - Adhoc All Payer", "methodology": "fee schedule", "standard_charge_dollar": 278.3 }, { "payer_name": "UHC - Adhoc", "plan_name": "UHC - Adhoc Oxford", "methodology": "fee schedule", "standard_charge_dollar": 278.3 }, { "payer_name": "Wellcare", "plan_name": "Wellcare Insurance Exchange", "methodology": "fee schedule", "standard_charge_dollar": 59.6, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 44.15, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup Medicare", "methodology": "fee schedule", "standard_charge_dollar": 44.15, "additional_payer_notes": "100.00% of Medicare Rates" } ] } ] }, { "description": "AORTIC AND HEART ASSIST PROCEDURES EXCEPT PULSATION BALLOON WITH MCC", "code_information": [ { "code": "268", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 81040.0, "minimum": 19777.3, "maximum": 146684.1557, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "case rate", "standard_charge_dollar": 146684.16, "additional_payer_notes": "181.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medical Rental Network", "methodology": "case rate", "standard_charge_dollar": 146684.16, "additional_payer_notes": "181.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "case rate", "standard_charge_dollar": 65380.4, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "ALLY-ALIGN (FKA SPARTAN PLAN NJ, INC.)", "plan_name": "ALLY-ALIGN (FKA SPARTAN PLAN NJ, INC.)", "methodology": "case rate", "standard_charge_dollar": 85093.02, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Americhoice (UHC)", "plan_name": "UHC Medicare", "methodology": "case rate", "standard_charge_dollar": 65380.4, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Amerihealth", "plan_name": "Amerihealth Medicare", "methodology": "case rate", "standard_charge_dollar": 65380.4, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Commercial", "methodology": "case rate", "standard_charge_dollar": 100623.68 }, { "payer_name": "Clover Health", "plan_name": "Clover Medicare", "methodology": "case rate", "standard_charge_dollar": 65380.4, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Coventry", "plan_name": "Coventry Auto", "methodology": "case rate", "standard_charge_dollar": 137769.65, "additional_payer_notes": "170.00% of Medicare Rates" }, { "payer_name": "Coventry", "plan_name": "Coventry Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 137769.65, "additional_payer_notes": "170.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "case rate", "standard_charge_dollar": 105353.26, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Fairprice Healthcare Holdings", "plan_name": "Fairprice Healthcare Holdings", "methodology": "case rate", "standard_charge_dollar": 129665.55, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon Medicare", "methodology": "case rate", "standard_charge_dollar": 65380.4, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon NJ Health Medicaid", "methodology": "case rate", "standard_charge_dollar": 41860.14 }, { "payer_name": "Humana", "plan_name": "Humana Military Tricare", "methodology": "case rate", "standard_charge_dollar": 64832.78, "additional_payer_notes": "80.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 81040.97, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 19777.3 }, { "payer_name": "UBH", "plan_name": "UBH Medicare", "methodology": "case rate", "standard_charge_dollar": 65380.4, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC All Payer (02-01-2023 to 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 115933.88 }, { "payer_name": "UHC", "plan_name": "UHC Oxford (02-01-2023 to 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 101036.35 }, { "payer_name": "UHC - Adhoc", "plan_name": "UHC - Adhoc All Payer", "methodology": "case rate", "standard_charge_dollar": 123066.26 }, { "payer_name": "UHC - Adhoc", "plan_name": "UHC - Adhoc Oxford", "methodology": "case rate", "standard_charge_dollar": 104117.65 }, { "payer_name": "Wellcare", "plan_name": "Wellcare Insurance Exchange", "methodology": "case rate", "standard_charge_dollar": 109405.31, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "case rate", "standard_charge_dollar": 65380.4, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup Medicare", "methodology": "case rate", "standard_charge_dollar": 65380.4, "additional_payer_notes": "100.00% of Medicare Rates" } ] } ] }, { "description": "MAJOR DEPRESSIVE DISORDERS & OTHERUNSPECIFIED PSYCHOSES - SOI : 3", "code_information": [ { "code": "7513", "type": "APR-DRG" } ], "standard_charges": [ { "setting": "inpatient", "minimum": 11000.59, "maximum": 12100.65, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Better Health - Medi Medi", "methodology": "case rate", "standard_charge_dollar": 12100.65, "additional_payer_notes": "110% of State Medicaid Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Better Health Medicaid", "methodology": "case rate", "standard_charge_dollar": 12100.65, "additional_payer_notes": "110% of State Medicaid Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "case rate", "standard_charge_dollar": 11000.59, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "UBH", "plan_name": "UBH Medicaid", "methodology": "case rate", "standard_charge_dollar": 11000.59, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicaid (02/01/2023 to 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 11220.6, "additional_payer_notes": "102% of State Medicaid Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicaid", "methodology": "case rate", "standard_charge_dollar": 11000.59, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup Medicaid", "methodology": "case rate", "standard_charge_dollar": 11000.59, "additional_payer_notes": "100% of State Medicaid Rates" } ] } ] }, { "description": "Hc App Skn Sub Head/Hnd/Ft/Gnt Ttl 100Sqcm 1St 25 Sqcm", "code_information": [ { "code": "15275", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 7486.49, "discounted_cash": 873.0, "minimum": 698.984, "maximum": 24234.0, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 1852.31, "additional_payer_notes": "212.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medical Rental Network", "methodology": "fee schedule", "standard_charge_dollar": 1852.31, "additional_payer_notes": "212.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 873.73, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "ALLY-ALIGN (FKA SPARTAN PLAN NJ, INC.)", "plan_name": "ALLY-ALIGN (FKA SPARTAN PLAN NJ, INC.)", "methodology": "fee schedule", "standard_charge_dollar": 917.42, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Americhoice (UHC)", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 873.73, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Amerihealth", "plan_name": "Amerihealth Medicare", "methodology": "fee schedule", "standard_charge_dollar": 873.73, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 1283.95, "additional_payer_notes": "146.95% of Medicare Rates" }, { "payer_name": "Clover Health", "plan_name": "Clover Medicare", "methodology": "fee schedule", "standard_charge_dollar": 873.73, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Coventry", "plan_name": "Coventry Auto", "methodology": "fee schedule", "standard_charge_dollar": 1747.46, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Coventry", "plan_name": "Coventry Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 1747.46, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "fee schedule", "standard_charge_dollar": 1223.22, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Fairprice Healthcare Holdings", "plan_name": "Fairprice Healthcare Holdings", "methodology": "fee schedule", "standard_charge_dollar": 1397.97, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ HMO POS", "methodology": "fee schedule", "standard_charge_dollar": 1549.12, "additional_payer_notes": "177.30% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ Indemnity", "methodology": "fee schedule", "standard_charge_dollar": 1549.12, "additional_payer_notes": "177.30% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ PPO", "methodology": "fee schedule", "standard_charge_dollar": 1549.12, "additional_payer_notes": "177.30% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon Medicare", "methodology": "fee schedule", "standard_charge_dollar": 873.73, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Military Tricare", "methodology": "fee schedule", "standard_charge_dollar": 698.98, "additional_payer_notes": "80.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 873.73, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 873.73, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC All Payer (02-01-2023 to 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 3912.0 }, { "payer_name": "UHC", "plan_name": "UHC Oxford (02-01-2023 to 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 3676.0 }, { "payer_name": "UHC - Adhoc", "plan_name": "UHC - Adhoc All Payer", "methodology": "case rate", "standard_charge_dollar": 4153.0 }, { "payer_name": "UHC - Adhoc", "plan_name": "UHC - Adhoc Oxford", "methodology": "case rate", "standard_charge_dollar": 3788.0 }, { "payer_name": "Wellcare", "plan_name": "Wellcare Insurance Exchange", "methodology": "fee schedule", "standard_charge_dollar": 1179.54, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 873.73, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellchoice", "plan_name": "WELLCHOICE HMO of NJ (Empire) Commercial (HMO / HMO POS, PPO)", "methodology": "case rate", "standard_charge_dollar": 1715.0 }, { "payer_name": "Wellchoice", "plan_name": "WELLCHOICE HMO of NJ (Empire) Commercial (Indemnity)", "methodology": "case rate", "standard_charge_dollar": 1978.0 }, { "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup Medicare", "methodology": "fee schedule", "standard_charge_dollar": 873.73, "additional_payer_notes": "100.00% of Medicare Rates" } ] } ] }, { "description": "MAJOR STOMACH, ESOPHAGEAL & DUODENAL PROCEDURES - SOI : 1", "code_information": [ { "code": "2201", "type": "APR-DRG" } ], "standard_charges": [ { "setting": "inpatient", "minimum": 17945.86, "maximum": 19740.44, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Better Health - Medi Medi", "methodology": "case rate", "standard_charge_dollar": 19740.44, "additional_payer_notes": "110% of State Medicaid Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Better Health Medicaid", "methodology": "case rate", "standard_charge_dollar": 19740.44, "additional_payer_notes": "110% of State Medicaid Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "case rate", "standard_charge_dollar": 17945.86, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "UBH", "plan_name": "UBH Medicaid", "methodology": "case rate", "standard_charge_dollar": 17945.86, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicaid (02/01/2023 to 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 18304.78, "additional_payer_notes": "102% of State Medicaid Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicaid", "methodology": "case rate", "standard_charge_dollar": 17945.86, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup Medicaid", "methodology": "case rate", "standard_charge_dollar": 17945.86, "additional_payer_notes": "100% of State Medicaid Rates" } ] } ] }, { "description": "SEIZURE - SOI : 3", "code_information": [ { "code": "0533", "type": "APR-DRG" } ], "standard_charges": [ { "setting": "inpatient", "minimum": 10616.46, "maximum": 11678.1, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Better Health - Medi Medi", "methodology": "case rate", "standard_charge_dollar": 11678.1, "additional_payer_notes": "110% of State Medicaid Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Better Health Medicaid", "methodology": "case rate", "standard_charge_dollar": 11678.1, "additional_payer_notes": "110% of State Medicaid Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "case rate", "standard_charge_dollar": 10616.46, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "UBH", "plan_name": "UBH Medicaid", "methodology": "case rate", "standard_charge_dollar": 10616.46, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicaid (02/01/2023 to 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 10828.79, "additional_payer_notes": "102% of State Medicaid Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicaid", "methodology": "case rate", "standard_charge_dollar": 10616.46, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup Medicaid", "methodology": "case rate", "standard_charge_dollar": 10616.46, "additional_payer_notes": "100% of State Medicaid Rates" } ] } ] }, { "description": "KNEE PROCEDURES WITH PRINCIPAL DIAGNOSIS OF INFECTION WITH CC", "code_information": [ { "code": "486", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 25722.0, "minimum": 13852.43, "maximum": 46557.6345, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "case rate", "standard_charge_dollar": 46557.63, "additional_payer_notes": "181.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medical Rental Network", "methodology": "case rate", "standard_charge_dollar": 46557.63, "additional_payer_notes": "181.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "case rate", "standard_charge_dollar": 20961.2, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "ALLY-ALIGN (FKA SPARTAN PLAN NJ, INC.)", "plan_name": "ALLY-ALIGN (FKA SPARTAN PLAN NJ, INC.)", "methodology": "case rate", "standard_charge_dollar": 27008.57, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Americhoice (UHC)", "plan_name": "UHC Medicare", "methodology": "case rate", "standard_charge_dollar": 20961.2, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Amerihealth", "plan_name": "Amerihealth Medicare", "methodology": "case rate", "standard_charge_dollar": 20961.2, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Commercial", "methodology": "case rate", "standard_charge_dollar": 30592.79 }, { "payer_name": "Clover Health", "plan_name": "Clover Medicare", "methodology": "case rate", "standard_charge_dollar": 20961.2, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Coventry", "plan_name": "Coventry Auto", "methodology": "case rate", "standard_charge_dollar": 43728.17, "additional_payer_notes": "170.00% of Medicare Rates" }, { "payer_name": "Coventry", "plan_name": "Coventry Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 43728.17, "additional_payer_notes": "170.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "case rate", "standard_charge_dollar": 33439.19, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Fairprice Healthcare Holdings", "plan_name": "Fairprice Healthcare Holdings", "methodology": "case rate", "standard_charge_dollar": 41155.92, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon Medicare", "methodology": "case rate", "standard_charge_dollar": 20961.2, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon NJ Health Medicaid", "methodology": "case rate", "standard_charge_dollar": 13852.43 }, { "payer_name": "Humana", "plan_name": "Humana Military Tricare", "methodology": "case rate", "standard_charge_dollar": 20577.96, "additional_payer_notes": "80.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 25722.45, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 22894.2 }, { "payer_name": "UBH", "plan_name": "UBH Medicare", "methodology": "case rate", "standard_charge_dollar": 20961.2, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC All Payer (02-01-2023 to 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 35247.58 }, { "payer_name": "UHC", "plan_name": "UHC Oxford (02-01-2023 to 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 30718.26 }, { "payer_name": "UHC - Adhoc", "plan_name": "UHC - Adhoc All Payer", "methodology": "case rate", "standard_charge_dollar": 37416.05 }, { "payer_name": "UHC - Adhoc", "plan_name": "UHC - Adhoc Oxford", "methodology": "case rate", "standard_charge_dollar": 31655.07 }, { "payer_name": "Wellcare", "plan_name": "Wellcare Insurance Exchange", "methodology": "case rate", "standard_charge_dollar": 34725.31, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "case rate", "standard_charge_dollar": 20961.2, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup Medicare", "methodology": "case rate", "standard_charge_dollar": 20961.2, "additional_payer_notes": "100.00% of Medicare Rates" } ] } ] }, { "description": "UTERINE & ADNEXA PROCEDURES FOR NON-MALIGNANCY EXCEPT LEIOMYOMA - SOI : 4", "code_information": [ { "code": "5134", "type": "APR-DRG" } ], "standard_charges": [ { "setting": "inpatient", "minimum": 39868.39, "maximum": 43855.23, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Better Health - Medi Medi", "methodology": "case rate", "standard_charge_dollar": 43855.23, "additional_payer_notes": "110% of State Medicaid Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Better Health Medicaid", "methodology": "case rate", "standard_charge_dollar": 43855.23, "additional_payer_notes": "110% of State Medicaid Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "case rate", "standard_charge_dollar": 39868.39, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "UBH", "plan_name": "UBH Medicaid", "methodology": "case rate", "standard_charge_dollar": 39868.39, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicaid (02/01/2023 to 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 40665.76, "additional_payer_notes": "102% of State Medicaid Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicaid", "methodology": "case rate", "standard_charge_dollar": 39868.39, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup Medicaid", "methodology": "case rate", "standard_charge_dollar": 39868.39, "additional_payer_notes": "100% of State Medicaid Rates" } ] } ] }, { "description": "HYPERTENSIVE ENCEPHALOPATHY WITH MCC", "code_information": [ { "code": "077", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "minimum": 9691.21, "maximum": 30128.976, "payers_information": [ { "payer_name": "Horizon", "plan_name": "Horizon NJ Health Medicaid", "methodology": "case rate", "standard_charge_dollar": 9691.21 }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 22497.0 } ] } ] }, { "description": "Hc Mr Angio, Head", "code_information": [ { "code": "70544", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 2975.9, "discounted_cash": 282.0, "minimum": 225.656, "maximum": 2529.515, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 597.99, "additional_payer_notes": "212.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medical Rental Network", "methodology": "fee schedule", "standard_charge_dollar": 597.99, "additional_payer_notes": "212.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 282.07, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "ALLY-ALIGN (FKA SPARTAN PLAN NJ, INC.)", "plan_name": "ALLY-ALIGN (FKA SPARTAN PLAN NJ, INC.)", "methodology": "fee schedule", "standard_charge_dollar": 296.17, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Americhoice (UHC)", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 282.07, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Amerihealth", "plan_name": "Amerihealth HMO", "methodology": "fee schedule", "standard_charge_dollar": 765.7 }, { "payer_name": "Amerihealth", "plan_name": "Amerihealth Medicare", "methodology": "fee schedule", "standard_charge_dollar": 282.07, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 414.5, "additional_payer_notes": "146.95% of Medicare Rates" }, { "payer_name": "Clover Health", "plan_name": "Clover Medicare", "methodology": "fee schedule", "standard_charge_dollar": 282.07, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Coventry", "plan_name": "Coventry Auto", "methodology": "fee schedule", "standard_charge_dollar": 564.14, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Coventry", "plan_name": "Coventry Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 564.14, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "fee schedule", "standard_charge_dollar": 394.9, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Fairprice Healthcare Holdings", "plan_name": "Fairprice Healthcare Holdings", "methodology": "fee schedule", "standard_charge_dollar": 451.31, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ HMO POS", "methodology": "fee schedule", "standard_charge_dollar": 500.11, "additional_payer_notes": "177.30% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ Indemnity", "methodology": "fee schedule", "standard_charge_dollar": 500.11, "additional_payer_notes": "177.30% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ PPO", "methodology": "fee schedule", "standard_charge_dollar": 500.11, "additional_payer_notes": "177.30% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon Medicare", "methodology": "fee schedule", "standard_charge_dollar": 282.07, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Military Tricare", "methodology": "fee schedule", "standard_charge_dollar": 225.66, "additional_payer_notes": "80.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 282.07, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 282.07, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC All Payer (02-01-2023 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 345.2 }, { "payer_name": "UHC", "plan_name": "UHC Medicaid (02/01/2023 to 12-31-2026)", "methodology": "percent of total billed charges", "standard_charge_percentage": 19.47, "median_amount": 566.11, "10th_percentile": 566.11, "90th_percentile": 566.11, "count": "1 through 10" }, { "payer_name": "UHC", "plan_name": "UHC Oxford (02-01-2023 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 345.2 }, { "payer_name": "UHC - Adhoc", "plan_name": "UHC - Adhoc All Payer", "methodology": "fee schedule", "standard_charge_dollar": 230.13 }, { "payer_name": "UHC - Adhoc", "plan_name": "UHC - Adhoc Oxford", "methodology": "fee schedule", "standard_charge_dollar": 230.13 }, { "payer_name": "Wellcare", "plan_name": "Wellcare Insurance Exchange", "methodology": "fee schedule", "standard_charge_dollar": 380.79, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 282.07, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup Medicare", "methodology": "fee schedule", "standard_charge_dollar": 282.07, "additional_payer_notes": "100.00% of Medicare Rates" } ] } ] }, { "description": "Hc Us,Transrectal,Prostate Vol", "code_information": [ { "code": "76873", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 1080.0, "discounted_cash": 123.0, "minimum": 98.872, "maximum": 918.0, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 262.01, "additional_payer_notes": "212.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medical Rental Network", "methodology": "fee schedule", "standard_charge_dollar": 262.01, "additional_payer_notes": "212.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 123.59, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "ALLY-ALIGN (FKA SPARTAN PLAN NJ, INC.)", "plan_name": "ALLY-ALIGN (FKA SPARTAN PLAN NJ, INC.)", "methodology": "fee schedule", "standard_charge_dollar": 129.77, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Americhoice (UHC)", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 123.59, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Amerihealth", "plan_name": "Amerihealth HMO", "methodology": "fee schedule", "standard_charge_dollar": 261.14 }, { "payer_name": "Amerihealth", "plan_name": "Amerihealth Medicare", "methodology": "fee schedule", "standard_charge_dollar": 123.59, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 181.62, "additional_payer_notes": "146.95% of Medicare Rates" }, { "payer_name": "Clover Health", "plan_name": "Clover Medicare", "methodology": "fee schedule", "standard_charge_dollar": 123.59, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Coventry", "plan_name": "Coventry Auto", "methodology": "fee schedule", "standard_charge_dollar": 247.18, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Coventry", "plan_name": "Coventry Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 247.18, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "fee schedule", "standard_charge_dollar": 173.03, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Fairprice Healthcare Holdings", "plan_name": "Fairprice Healthcare Holdings", "methodology": "fee schedule", "standard_charge_dollar": 197.74, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ HMO POS", "methodology": "fee schedule", "standard_charge_dollar": 219.13, "additional_payer_notes": "177.30% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ Indemnity", "methodology": "fee schedule", "standard_charge_dollar": 219.13, "additional_payer_notes": "177.30% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ PPO", "methodology": "fee schedule", "standard_charge_dollar": 219.13, "additional_payer_notes": "177.30% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon Medicare", "methodology": "fee schedule", "standard_charge_dollar": 123.59, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Military Tricare", "methodology": "fee schedule", "standard_charge_dollar": 98.87, "additional_payer_notes": "80.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 123.59, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 123.59, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC All Payer (02-01-2023 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 163.46 }, { "payer_name": "UHC", "plan_name": "UHC Oxford (02-01-2023 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 163.46 }, { "payer_name": "UHC - Adhoc", "plan_name": "UHC - Adhoc All Payer", "methodology": "fee schedule", "standard_charge_dollar": 108.97 }, { "payer_name": "UHC - Adhoc", "plan_name": "UHC - Adhoc Oxford", "methodology": "fee schedule", "standard_charge_dollar": 108.97 }, { "payer_name": "Wellcare", "plan_name": "Wellcare Insurance Exchange", "methodology": "fee schedule", "standard_charge_dollar": 166.85, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 123.59, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup Medicare", "methodology": "fee schedule", "standard_charge_dollar": 123.59, "additional_payer_notes": "100.00% of Medicare Rates" } ] } ] }, { "description": "HIV W MULTIPLE SIGNIFICANT HIV RELATED CONDITIONS - SOI : 4", "code_information": [ { "code": "8934", "type": "APR-DRG" } ], "standard_charges": [ { "setting": "inpatient", "minimum": 20374.38, "maximum": 22411.82, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Better Health - Medi Medi", "methodology": "case rate", "standard_charge_dollar": 22411.82, "additional_payer_notes": "110% of State Medicaid Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Better Health Medicaid", "methodology": "case rate", "standard_charge_dollar": 22411.82, "additional_payer_notes": "110% of State Medicaid Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "case rate", "standard_charge_dollar": 20374.38, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "UBH", "plan_name": "UBH Medicaid", "methodology": "case rate", "standard_charge_dollar": 20374.38, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicaid (02/01/2023 to 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 20781.87, "additional_payer_notes": "102% of State Medicaid Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicaid", "methodology": "case rate", "standard_charge_dollar": 20374.38, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup Medicaid", "methodology": "case rate", "standard_charge_dollar": 20374.38, "additional_payer_notes": "100% of State Medicaid Rates" } ] } ] }, { "description": "EATING DISORDERS - SOI : 1", "code_information": [ { "code": "7591", "type": "APR-DRG" } ], "standard_charges": [ { "setting": "inpatient", "minimum": 9710.29, "maximum": 10681.32, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Better Health - Medi Medi", "methodology": "case rate", "standard_charge_dollar": 10681.32, "additional_payer_notes": "110% of State Medicaid Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Better Health Medicaid", "methodology": "case rate", "standard_charge_dollar": 10681.32, "additional_payer_notes": "110% of State Medicaid Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "case rate", "standard_charge_dollar": 9710.29, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "UBH", "plan_name": "UBH Medicaid", "methodology": "case rate", "standard_charge_dollar": 9710.29, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicaid (02/01/2023 to 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 9904.49, "additional_payer_notes": "102% of State Medicaid Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicaid", "methodology": "case rate", "standard_charge_dollar": 9710.29, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup Medicaid", "methodology": "case rate", "standard_charge_dollar": 9710.29, "additional_payer_notes": "100% of State Medicaid Rates" } ] } ] }, { "description": "AMPUTATION OF LOWER LIMB FOR ENDOCRINE, NUTRITIONAL AND METABOLIC DISORDERS WITH CC", "code_information": [ { "code": "617", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 23170.0, "minimum": 12948.25, "maximum": 41939.1299, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "case rate", "standard_charge_dollar": 41939.13, "additional_payer_notes": "181.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medical Rental Network", "methodology": "case rate", "standard_charge_dollar": 41939.13, "additional_payer_notes": "181.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "case rate", "standard_charge_dollar": 18912.2, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "ALLY-ALIGN (FKA SPARTAN PLAN NJ, INC.)", "plan_name": "ALLY-ALIGN (FKA SPARTAN PLAN NJ, INC.)", "methodology": "case rate", "standard_charge_dollar": 24329.33, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Americhoice (UHC)", "plan_name": "UHC Medicare", "methodology": "case rate", "standard_charge_dollar": 18912.2, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Amerihealth", "plan_name": "Amerihealth Medicare", "methodology": "case rate", "standard_charge_dollar": 18912.2, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Commercial", "methodology": "case rate", "standard_charge_dollar": 27362.49 }, { "payer_name": "Clover Health", "plan_name": "Clover Medicare", "methodology": "case rate", "standard_charge_dollar": 18912.2, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Coventry", "plan_name": "Coventry Auto", "methodology": "case rate", "standard_charge_dollar": 39390.34, "additional_payer_notes": "170.00% of Medicare Rates" }, { "payer_name": "Coventry", "plan_name": "Coventry Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 39390.34, "additional_payer_notes": "170.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "case rate", "standard_charge_dollar": 30122.03, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Fairprice Healthcare Holdings", "plan_name": "Fairprice Healthcare Holdings", "methodology": "case rate", "standard_charge_dollar": 37073.26, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon Medicare", "methodology": "case rate", "standard_charge_dollar": 18912.2, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon NJ Health Medicaid", "methodology": "case rate", "standard_charge_dollar": 12948.25 }, { "payer_name": "Humana", "plan_name": "Humana Military Tricare", "methodology": "case rate", "standard_charge_dollar": 18536.63, "additional_payer_notes": "80.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 23170.79, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 19924.1 }, { "payer_name": "UBH", "plan_name": "UBH Medicare", "methodology": "case rate", "standard_charge_dollar": 18912.2, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC All Payer (02-01-2023 to 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 31525.78 }, { "payer_name": "UHC", "plan_name": "UHC Oxford (02-01-2023 to 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 27474.71 }, { "payer_name": "UHC - Adhoc", "plan_name": "UHC - Adhoc All Payer", "methodology": "case rate", "standard_charge_dollar": 33465.28 }, { "payer_name": "UHC - Adhoc", "plan_name": "UHC - Adhoc Oxford", "methodology": "case rate", "standard_charge_dollar": 28312.6 }, { "payer_name": "Wellcare", "plan_name": "Wellcare Insurance Exchange", "methodology": "case rate", "standard_charge_dollar": 31280.57, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "case rate", "standard_charge_dollar": 18912.2, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup Medicare", "methodology": "case rate", "standard_charge_dollar": 18912.2, "additional_payer_notes": "100.00% of Medicare Rates" } ] } ] }, { "description": "MAJOR RESPIRATORY INFECTIONS & INFLAMMATIONS - SOI : 4", "code_information": [ { "code": "1374", "type": "APR-DRG" } ], "standard_charges": [ { "setting": "inpatient", "minimum": 21745.93, "maximum": 23920.53, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Better Health - Medi Medi", "methodology": "case rate", "standard_charge_dollar": 23920.53, "additional_payer_notes": "110% of State Medicaid Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Better Health Medicaid", "methodology": "case rate", "standard_charge_dollar": 23920.53, "additional_payer_notes": "110% of State Medicaid Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "case rate", "standard_charge_dollar": 21745.93, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "UBH", "plan_name": "UBH Medicaid", "methodology": "case rate", "standard_charge_dollar": 21745.93, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicaid (02/01/2023 to 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 22180.85, "additional_payer_notes": "102% of State Medicaid Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicaid", "methodology": "case rate", "standard_charge_dollar": 21745.93, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup Medicaid", "methodology": "case rate", "standard_charge_dollar": 21745.93, "additional_payer_notes": "100% of State Medicaid Rates" } ] } ] }, { "description": "PERIPHERAL, CRANIAL NERVE AND OTHER NERVOUS SYSTEM PROCEDURES WITH CC OR PERIPHERAL NEUROSTIMULATOR", "code_information": [ { "code": "041", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 26965.0, "minimum": 14726.64, "maximum": 48808.3333, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "case rate", "standard_charge_dollar": 48808.33, "additional_payer_notes": "181.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medical Rental Network", "methodology": "case rate", "standard_charge_dollar": 48808.33, "additional_payer_notes": "181.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "case rate", "standard_charge_dollar": 21959.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "ALLY-ALIGN (FKA SPARTAN PLAN NJ, INC.)", "plan_name": "ALLY-ALIGN (FKA SPARTAN PLAN NJ, INC.)", "methodology": "case rate", "standard_charge_dollar": 28314.23, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Americhoice (UHC)", "plan_name": "UHC Medicare", "methodology": "case rate", "standard_charge_dollar": 21959.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Amerihealth", "plan_name": "Amerihealth Medicare", "methodology": "case rate", "standard_charge_dollar": 21959.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Commercial", "methodology": "case rate", "standard_charge_dollar": 32166.98 }, { "payer_name": "Clover Health", "plan_name": "Clover Medicare", "methodology": "case rate", "standard_charge_dollar": 21959.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Coventry", "plan_name": "Coventry Auto", "methodology": "case rate", "standard_charge_dollar": 45842.08, "additional_payer_notes": "170.00% of Medicare Rates" }, { "payer_name": "Coventry", "plan_name": "Coventry Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 45842.08, "additional_payer_notes": "170.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "case rate", "standard_charge_dollar": 35055.71, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Fairprice Healthcare Holdings", "plan_name": "Fairprice Healthcare Holdings", "methodology": "case rate", "standard_charge_dollar": 43145.49, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon Medicare", "methodology": "case rate", "standard_charge_dollar": 21959.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon NJ Health Medicaid", "methodology": "case rate", "standard_charge_dollar": 14726.64 }, { "payer_name": "Humana", "plan_name": "Humana Military Tricare", "methodology": "case rate", "standard_charge_dollar": 21572.74, "additional_payer_notes": "80.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 26965.93, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 32715.3 }, { "payer_name": "UBH", "plan_name": "UBH Medicare", "methodology": "case rate", "standard_charge_dollar": 21959.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC All Payer (02-01-2023 to 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 37061.29 }, { "payer_name": "UHC", "plan_name": "UHC Oxford (02-01-2023 to 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 32298.9 }, { "payer_name": "UHC - Adhoc", "plan_name": "UHC - Adhoc All Payer", "methodology": "case rate", "standard_charge_dollar": 39341.34 }, { "payer_name": "UHC - Adhoc", "plan_name": "UHC - Adhoc Oxford", "methodology": "case rate", "standard_charge_dollar": 33283.92 }, { "payer_name": "Wellcare", "plan_name": "Wellcare Insurance Exchange", "methodology": "case rate", "standard_charge_dollar": 36404.01, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "case rate", "standard_charge_dollar": 21959.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup Medicare", "methodology": "case rate", "standard_charge_dollar": 21959.6, "additional_payer_notes": "100.00% of Medicare Rates" } ] } ] }, { "description": "Cystourethroscopy", "code_information": [ { "code": "52000", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 16350.0, "discounted_cash": 824.0, "minimum": 659.472, "maximum": 13080.0, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 1747.6, "additional_payer_notes": "212.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medical Rental Network", "methodology": "fee schedule", "standard_charge_dollar": 1747.6, "additional_payer_notes": "212.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 824.34, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "ALLY-ALIGN (FKA SPARTAN PLAN NJ, INC.)", "plan_name": "ALLY-ALIGN (FKA SPARTAN PLAN NJ, INC.)", "methodology": "fee schedule", "standard_charge_dollar": 865.56, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Americhoice (UHC)", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 824.34, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Amerihealth", "plan_name": "Amerihealth Medicare", "methodology": "fee schedule", "standard_charge_dollar": 824.34, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 1211.37, "additional_payer_notes": "146.95% of Medicare Rates" }, { "payer_name": "Clover Health", "plan_name": "Clover Medicare", "methodology": "fee schedule", "standard_charge_dollar": 824.34, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Coventry", "plan_name": "Coventry Auto", "methodology": "fee schedule", "standard_charge_dollar": 1648.68, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Coventry", "plan_name": "Coventry Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 1648.68, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "fee schedule", "standard_charge_dollar": 1154.08, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Fairprice Healthcare Holdings", "plan_name": "Fairprice Healthcare Holdings", "methodology": "fee schedule", "standard_charge_dollar": 1318.94, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ HMO POS", "methodology": "fee schedule", "standard_charge_dollar": 1461.55, "additional_payer_notes": "177.30% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ Indemnity", "methodology": "fee schedule", "standard_charge_dollar": 1461.55, "additional_payer_notes": "177.30% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ PPO", "methodology": "fee schedule", "standard_charge_dollar": 1461.55, "additional_payer_notes": "177.30% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon Medicare", "methodology": "fee schedule", "standard_charge_dollar": 824.34, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon NJ Health Medicaid", "methodology": "percent of total billed charges", "standard_charge_percentage": 19.58, "median_amount": 2511.14, "10th_percentile": 2511.14, "90th_percentile": 2511.14, "count": "1 through 10" }, { "payer_name": "Humana", "plan_name": "Humana Military Tricare", "methodology": "fee schedule", "standard_charge_dollar": 659.47, "additional_payer_notes": "80.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 824.34, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 824.34, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC All Payer (02-01-2023 to 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 3147.0 }, { "payer_name": "UHC", "plan_name": "UHC Oxford (02-01-2023 to 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 2297.0 }, { "payer_name": "UHC - Adhoc", "plan_name": "UHC - Adhoc All Payer", "methodology": "case rate", "standard_charge_dollar": 3341.0 }, { "payer_name": "UHC - Adhoc", "plan_name": "UHC - Adhoc Oxford", "methodology": "case rate", "standard_charge_dollar": 2367.0 }, { "payer_name": "Wellcare", "plan_name": "Wellcare Insurance Exchange", "methodology": "fee schedule", "standard_charge_dollar": 1112.86, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 824.34, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellchoice", "plan_name": "WELLCHOICE HMO of NJ (Empire) Commercial (HMO / HMO POS, PPO)", "methodology": "case rate", "standard_charge_dollar": 1715.0 }, { "payer_name": "Wellchoice", "plan_name": "WELLCHOICE HMO of NJ (Empire) Commercial (Indemnity)", "methodology": "case rate", "standard_charge_dollar": 1978.0 }, { "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup Medicare", "methodology": "fee schedule", "standard_charge_dollar": 824.34, "additional_payer_notes": "100.00% of Medicare Rates" } ] } ] }, { "description": "Hc Serum Immunoelectrophoresis", "code_information": [ { "code": "86320", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 66.0, "discounted_cash": 29.0, "minimum": 12.5994, "maximum": 63.4304, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 63.43, "additional_payer_notes": "212.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medical Rental Network", "methodology": "fee schedule", "standard_charge_dollar": 63.43, "additional_payer_notes": "212.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 29.92, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "ALLY-ALIGN (FKA SPARTAN PLAN NJ, INC.)", "plan_name": "ALLY-ALIGN (FKA SPARTAN PLAN NJ, INC.)", "methodology": "fee schedule", "standard_charge_dollar": 31.42, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Americhoice (UHC)", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 29.92, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Amerihealth", "plan_name": "Amerihealth Medicare", "methodology": "fee schedule", "standard_charge_dollar": 29.92, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 43.38, "additional_payer_notes": "Laboratory - 145.00% of Medicare Rates" }, { "payer_name": "Clover Health", "plan_name": "Clover Medicare", "methodology": "fee schedule", "standard_charge_dollar": 29.92, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Coventry", "plan_name": "Coventry Auto", "methodology": "fee schedule", "standard_charge_dollar": 59.84, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Coventry", "plan_name": "Coventry Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 59.84, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "fee schedule", "standard_charge_dollar": 41.89, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Fairprice Healthcare Holdings", "plan_name": "Fairprice Healthcare Holdings", "methodology": "fee schedule", "standard_charge_dollar": 35.9, "additional_payer_notes": "Laboratory - 120.00% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ HMO POS", "methodology": "fee schedule", "standard_charge_dollar": 46.6, "additional_payer_notes": "177.30% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ Indemnity", "methodology": "fee schedule", "standard_charge_dollar": 46.6, "additional_payer_notes": "177.30% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ PPO", "methodology": "fee schedule", "standard_charge_dollar": 46.6, "additional_payer_notes": "177.30% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon Medicare", "methodology": "fee schedule", "standard_charge_dollar": 29.92, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Military Tricare", "methodology": "fee schedule", "standard_charge_dollar": 23.94, "additional_payer_notes": "80.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 29.92, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 29.92, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC All Payer (02-01-2023 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 17.95 }, { "payer_name": "UHC", "plan_name": "UHC Medicaid (02/01/2023 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 23.94 }, { "payer_name": "UHC", "plan_name": "UHC Oxford (02-01-2023 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 17.95 }, { "payer_name": "UHC - Adhoc", "plan_name": "UHC - Adhoc All Payer", "methodology": "fee schedule", "standard_charge_dollar": 29.92 }, { "payer_name": "UHC - Adhoc", "plan_name": "UHC - Adhoc Oxford", "methodology": "fee schedule", "standard_charge_dollar": 29.92 }, { "payer_name": "Wellcare", "plan_name": "Wellcare Insurance Exchange", "methodology": "fee schedule", "standard_charge_dollar": 40.39, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 29.92, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup Medicare", "methodology": "fee schedule", "standard_charge_dollar": 29.92, "additional_payer_notes": "100.00% of Medicare Rates" } ] } ] }, { "description": "Hc Insert,Non-Indwelling Bladder Catheter", "code_information": [ { "code": "51701", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 524.41, "discounted_cash": 157.0, "minimum": 100.1099, "maximum": 524.41, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 333.45, "additional_payer_notes": "212.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medical Rental Network", "methodology": "fee schedule", "standard_charge_dollar": 333.45, "additional_payer_notes": "212.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 157.29, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "ALLY-ALIGN (FKA SPARTAN PLAN NJ, INC.)", "plan_name": "ALLY-ALIGN (FKA SPARTAN PLAN NJ, INC.)", "methodology": "fee schedule", "standard_charge_dollar": 165.15, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Americhoice (UHC)", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 157.29, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Amerihealth", "plan_name": "Amerihealth Medicare", "methodology": "fee schedule", "standard_charge_dollar": 157.29, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 231.14, "additional_payer_notes": "146.95% of Medicare Rates" }, { "payer_name": "Clover Health", "plan_name": "Clover Medicare", "methodology": "fee schedule", "standard_charge_dollar": 157.29, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Coventry", "plan_name": "Coventry Auto", "methodology": "fee schedule", "standard_charge_dollar": 314.58, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Coventry", "plan_name": "Coventry Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 314.58, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "fee schedule", "standard_charge_dollar": 220.21, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Fairprice Healthcare Holdings", "plan_name": "Fairprice Healthcare Holdings", "methodology": "fee schedule", "standard_charge_dollar": 251.66, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ HMO POS", "methodology": "fee schedule", "standard_charge_dollar": 278.88, "additional_payer_notes": "177.30% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ Indemnity", "methodology": "fee schedule", "standard_charge_dollar": 278.88, "additional_payer_notes": "177.30% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ PPO", "methodology": "fee schedule", "standard_charge_dollar": 278.88, "additional_payer_notes": "177.30% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon Medicare", "methodology": "fee schedule", "standard_charge_dollar": 157.29, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Military Tricare", "methodology": "fee schedule", "standard_charge_dollar": 125.83, "additional_payer_notes": "80.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 157.29, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 157.29, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC All Payer (02-01-2023 to 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 524.41 }, { "payer_name": "UHC", "plan_name": "UHC Oxford (02-01-2023 to 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 524.41 }, { "payer_name": "UHC - Adhoc", "plan_name": "UHC - Adhoc All Payer", "methodology": "case rate", "standard_charge_dollar": 524.41 }, { "payer_name": "UHC - Adhoc", "plan_name": "UHC - Adhoc Oxford", "methodology": "case rate", "standard_charge_dollar": 524.41 }, { "payer_name": "Wellcare", "plan_name": "Wellcare Insurance Exchange", "methodology": "fee schedule", "standard_charge_dollar": 212.34, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 157.29, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellchoice", "plan_name": "WELLCHOICE HMO of NJ (Empire) Commercial (HMO / HMO POS, PPO)", "methodology": "case rate", "standard_charge_dollar": 524.41 }, { "payer_name": "Wellchoice", "plan_name": "WELLCHOICE HMO of NJ (Empire) Commercial (Indemnity)", "methodology": "case rate", "standard_charge_dollar": 524.41 }, { "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup Medicare", "methodology": "fee schedule", "standard_charge_dollar": 157.29, "additional_payer_notes": "100.00% of Medicare Rates" } ] } ] }, { "description": "Hc Family Psytx W/O Patient", "code_information": [ { "code": "90846", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 704.0, "discounted_cash": 209.0, "minimum": 113.94, "maximum": 598.4, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 444.84, "additional_payer_notes": "212.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medical Rental Network", "methodology": "fee schedule", "standard_charge_dollar": 444.84, "additional_payer_notes": "212.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 209.83, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "ALLY-ALIGN (FKA SPARTAN PLAN NJ, INC.)", "plan_name": "ALLY-ALIGN (FKA SPARTAN PLAN NJ, INC.)", "methodology": "fee schedule", "standard_charge_dollar": 220.32, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Americhoice (UHC)", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 209.83, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Amerihealth", "plan_name": "Amerihealth HMO", "methodology": "fee schedule", "standard_charge_dollar": 120.26 }, { "payer_name": "Amerihealth", "plan_name": "Amerihealth Medicare", "methodology": "fee schedule", "standard_charge_dollar": 120.26, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 308.35, "additional_payer_notes": "146.95% of Medicare Rates" }, { "payer_name": "Clover Health", "plan_name": "Clover Medicare", "methodology": "fee schedule", "standard_charge_dollar": 209.83, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Coventry", "plan_name": "Coventry Auto", "methodology": "fee schedule", "standard_charge_dollar": 419.66, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Coventry", "plan_name": "Coventry Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 419.66, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "fee schedule", "standard_charge_dollar": 293.76, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Fairprice Healthcare Holdings", "plan_name": "Fairprice Healthcare Holdings", "methodology": "fee schedule", "standard_charge_dollar": 335.73, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ HMO POS", "methodology": "fee schedule", "standard_charge_dollar": 372.03, "additional_payer_notes": "177.30% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ Indemnity", "methodology": "fee schedule", "standard_charge_dollar": 372.03, "additional_payer_notes": "177.30% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ PPO", "methodology": "fee schedule", "standard_charge_dollar": 372.03, "additional_payer_notes": "177.30% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon Medicare", "methodology": "fee schedule", "standard_charge_dollar": 209.83, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon NJ Health Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 113.94 }, { "payer_name": "Humana", "plan_name": "Humana Military Tricare", "methodology": "fee schedule", "standard_charge_dollar": 167.86, "additional_payer_notes": "80.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 209.83, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 209.83, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Insurance Exchange", "methodology": "fee schedule", "standard_charge_dollar": 283.27, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 209.83, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup Medicare", "methodology": "fee schedule", "standard_charge_dollar": 209.83, "additional_payer_notes": "100.00% of Medicare Rates" } ] } ] }, { "description": "Hc Program Eval Implantable In Persn 1 Ld Card/Dfb", "code_information": [ { "code": "93282", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 254.0, "discounted_cash": 44.0, "minimum": 35.288, "maximum": 254.0, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 93.51, "additional_payer_notes": "212.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medical Rental Network", "methodology": "fee schedule", "standard_charge_dollar": 93.51, "additional_payer_notes": "212.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 44.11, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "ALLY-ALIGN (FKA SPARTAN PLAN NJ, INC.)", "plan_name": "ALLY-ALIGN (FKA SPARTAN PLAN NJ, INC.)", "methodology": "fee schedule", "standard_charge_dollar": 46.32, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Americhoice (UHC)", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 44.11, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Amerihealth", "plan_name": "Amerihealth Medicare", "methodology": "fee schedule", "standard_charge_dollar": 44.11, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 64.82, "additional_payer_notes": "146.95% of Medicare Rates" }, { "payer_name": "Clover Health", "plan_name": "Clover Medicare", "methodology": "fee schedule", "standard_charge_dollar": 44.11, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Coventry", "plan_name": "Coventry Auto", "methodology": "fee schedule", "standard_charge_dollar": 88.22, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Coventry", "plan_name": "Coventry Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 88.22, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "fee schedule", "standard_charge_dollar": 61.75, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Fairprice Healthcare Holdings", "plan_name": "Fairprice Healthcare Holdings", "methodology": "fee schedule", "standard_charge_dollar": 70.58, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ HMO POS", "methodology": "fee schedule", "standard_charge_dollar": 78.21, "additional_payer_notes": "177.30% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ Indemnity", "methodology": "fee schedule", "standard_charge_dollar": 78.21, "additional_payer_notes": "177.30% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ PPO", "methodology": "fee schedule", "standard_charge_dollar": 78.21, "additional_payer_notes": "177.30% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon Medicare", "methodology": "fee schedule", "standard_charge_dollar": 44.11, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Military Tricare", "methodology": "fee schedule", "standard_charge_dollar": 35.29, "additional_payer_notes": "80.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 44.11, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 44.11, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC All Payer (02-01-2023 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 254.0 }, { "payer_name": "UHC", "plan_name": "UHC Oxford (02-01-2023 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 254.0 }, { "payer_name": "UHC - Adhoc", "plan_name": "UHC - Adhoc All Payer", "methodology": "fee schedule", "standard_charge_dollar": 254.0 }, { "payer_name": "UHC - Adhoc", "plan_name": "UHC - Adhoc Oxford", "methodology": "fee schedule", "standard_charge_dollar": 254.0 }, { "payer_name": "Wellcare", "plan_name": "Wellcare Insurance Exchange", "methodology": "fee schedule", "standard_charge_dollar": 59.55, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 44.11, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellchoice", "plan_name": "WELLCHOICE HMO of NJ (Empire) Commercial (HMO / HMO POS, PPO)", "methodology": "case rate", "standard_charge_dollar": 254.0 }, { "payer_name": "Wellchoice", "plan_name": "WELLCHOICE HMO of NJ (Empire) Commercial (Indemnity)", "methodology": "case rate", "standard_charge_dollar": 254.0 }, { "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup Medicare", "methodology": "fee schedule", "standard_charge_dollar": 44.11, "additional_payer_notes": "100.00% of Medicare Rates" } ] } ] }, { "description": "MAJOR HEAD AND NECK PROCEDURES WITHOUT CCMCC", "code_information": [ { "code": "142", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 20005.0, "minimum": 16004.376, "maximum": 36209.9007, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "case rate", "standard_charge_dollar": 36209.9, "additional_payer_notes": "181.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medical Rental Network", "methodology": "case rate", "standard_charge_dollar": 36209.9, "additional_payer_notes": "181.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "case rate", "standard_charge_dollar": 16370.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "ALLY-ALIGN (FKA SPARTAN PLAN NJ, INC.)", "plan_name": "ALLY-ALIGN (FKA SPARTAN PLAN NJ, INC.)", "methodology": "case rate", "standard_charge_dollar": 21005.74, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Americhoice (UHC)", "plan_name": "UHC Medicare", "methodology": "case rate", "standard_charge_dollar": 16370.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Amerihealth", "plan_name": "Amerihealth Medicare", "methodology": "case rate", "standard_charge_dollar": 16370.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Commercial", "methodology": "case rate", "standard_charge_dollar": 23355.33 }, { "payer_name": "Clover Health", "plan_name": "Clover Medicare", "methodology": "case rate", "standard_charge_dollar": 16370.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Coventry", "plan_name": "Coventry Auto", "methodology": "case rate", "standard_charge_dollar": 34009.3, "additional_payer_notes": "170.00% of Medicare Rates" }, { "payer_name": "Coventry", "plan_name": "Coventry Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 34009.3, "additional_payer_notes": "170.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "case rate", "standard_charge_dollar": 26007.11, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Fairprice Healthcare Holdings", "plan_name": "Fairprice Healthcare Holdings", "methodology": "case rate", "standard_charge_dollar": 32008.75, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon Medicare", "methodology": "case rate", "standard_charge_dollar": 16370.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Military Tricare", "methodology": "case rate", "standard_charge_dollar": 16004.38, "additional_payer_notes": "80.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 20005.47, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 23376.5 }, { "payer_name": "UBH", "plan_name": "UBH Medicare", "methodology": "case rate", "standard_charge_dollar": 16370.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC All Payer (02-01-2023 to 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 26908.92 }, { "payer_name": "UHC", "plan_name": "UHC Oxford (02-01-2023 to 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 23451.12 }, { "payer_name": "UHC - Adhoc", "plan_name": "UHC - Adhoc All Payer", "methodology": "case rate", "standard_charge_dollar": 28564.39 }, { "payer_name": "UHC - Adhoc", "plan_name": "UHC - Adhoc Oxford", "methodology": "case rate", "standard_charge_dollar": 24166.3 }, { "payer_name": "Wellcare", "plan_name": "Wellcare Insurance Exchange", "methodology": "case rate", "standard_charge_dollar": 27007.38, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "case rate", "standard_charge_dollar": 16370.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup Medicare", "methodology": "case rate", "standard_charge_dollar": 16370.6, "additional_payer_notes": "100.00% of Medicare Rates" } ] } ] }, { "description": "Hc Assay Of Tacrolimus", "code_information": [ { "code": "80197", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 486.0, "discounted_cash": 13.0, "minimum": 8.24, "maximum": 413.1, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 29.11, "additional_payer_notes": "212.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medical Rental Network", "methodology": "fee schedule", "standard_charge_dollar": 29.11, "additional_payer_notes": "212.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 13.73, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "ALLY-ALIGN (FKA SPARTAN PLAN NJ, INC.)", "plan_name": "ALLY-ALIGN (FKA SPARTAN PLAN NJ, INC.)", "methodology": "fee schedule", "standard_charge_dollar": 14.42, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Americhoice (UHC)", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 13.73, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Amerihealth", "plan_name": "Amerihealth Medicare", "methodology": "fee schedule", "standard_charge_dollar": 13.73, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 19.91, "additional_payer_notes": "Laboratory - 145.00% of Medicare Rates" }, { "payer_name": "Clover Health", "plan_name": "Clover Medicare", "methodology": "fee schedule", "standard_charge_dollar": 13.73, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Coventry", "plan_name": "Coventry Auto", "methodology": "fee schedule", "standard_charge_dollar": 27.46, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Coventry", "plan_name": "Coventry Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 27.46, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "fee schedule", "standard_charge_dollar": 19.22, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Fairprice Healthcare Holdings", "plan_name": "Fairprice Healthcare Holdings", "methodology": "fee schedule", "standard_charge_dollar": 16.48, "additional_payer_notes": "Laboratory - 120.00% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ HMO POS", "methodology": "fee schedule", "standard_charge_dollar": 343.12, "additional_payer_notes": "177.30% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ Indemnity", "methodology": "fee schedule", "standard_charge_dollar": 343.12, "additional_payer_notes": "177.30% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ PPO", "methodology": "fee schedule", "standard_charge_dollar": 343.12, "additional_payer_notes": "177.30% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon Medicare", "methodology": "fee schedule", "standard_charge_dollar": 13.73, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Military Tricare", "methodology": "fee schedule", "standard_charge_dollar": 10.98, "additional_payer_notes": "80.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 13.73, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 13.73, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC All Payer (02-01-2023 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 8.24 }, { "payer_name": "UHC", "plan_name": "UHC Medicaid (02/01/2023 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 10.98 }, { "payer_name": "UHC", "plan_name": "UHC Oxford (02-01-2023 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 8.24 }, { "payer_name": "UHC - Adhoc", "plan_name": "UHC - Adhoc All Payer", "methodology": "fee schedule", "standard_charge_dollar": 13.73 }, { "payer_name": "UHC - Adhoc", "plan_name": "UHC - Adhoc Oxford", "methodology": "fee schedule", "standard_charge_dollar": 13.73 }, { "payer_name": "Wellcare", "plan_name": "Wellcare Insurance Exchange", "methodology": "fee schedule", "standard_charge_dollar": 18.54, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 13.73, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup Medicare", "methodology": "fee schedule", "standard_charge_dollar": 13.73, "additional_payer_notes": "100.00% of Medicare Rates" } ] } ] }, { "description": "LYMPHOMA AND NON-ACUTE LEUKEMIA WITHOUT CCMCC", "code_information": [ { "code": "842", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 13233.0, "minimum": 7000.52, "maximum": 23952.4178, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "case rate", "standard_charge_dollar": 23952.42, "additional_payer_notes": "181.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medical Rental Network", "methodology": "case rate", "standard_charge_dollar": 23952.42, "additional_payer_notes": "181.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "case rate", "standard_charge_dollar": 10932.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "ALLY-ALIGN (FKA SPARTAN PLAN NJ, INC.)", "plan_name": "ALLY-ALIGN (FKA SPARTAN PLAN NJ, INC.)", "methodology": "case rate", "standard_charge_dollar": 13895.05, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Americhoice (UHC)", "plan_name": "UHC Medicare", "methodology": "case rate", "standard_charge_dollar": 10932.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Amerihealth", "plan_name": "Amerihealth Medicare", "methodology": "case rate", "standard_charge_dollar": 10932.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Commercial", "methodology": "case rate", "standard_charge_dollar": 14782.15 }, { "payer_name": "Clover Health", "plan_name": "Clover Medicare", "methodology": "case rate", "standard_charge_dollar": 10932.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Coventry", "plan_name": "Coventry Auto", "methodology": "case rate", "standard_charge_dollar": 22496.75, "additional_payer_notes": "170.00% of Medicare Rates" }, { "payer_name": "Coventry", "plan_name": "Coventry Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 22496.75, "additional_payer_notes": "170.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "case rate", "standard_charge_dollar": 17203.39, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Fairprice Healthcare Holdings", "plan_name": "Fairprice Healthcare Holdings", "methodology": "case rate", "standard_charge_dollar": 21173.41, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon Medicare", "methodology": "case rate", "standard_charge_dollar": 10932.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon NJ Health Medicaid", "methodology": "case rate", "standard_charge_dollar": 7000.52 }, { "payer_name": "Humana", "plan_name": "Humana Military Tricare", "methodology": "case rate", "standard_charge_dollar": 10586.7, "additional_payer_notes": "80.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 13233.38, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 10743.9 }, { "payer_name": "UBH", "plan_name": "UBH Medicare", "methodology": "case rate", "standard_charge_dollar": 10932.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC All Payer (02-01-2023 to 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 17031.3 }, { "payer_name": "UHC", "plan_name": "UHC Oxford (02-01-2023 to 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 14842.78 }, { "payer_name": "UHC - Adhoc", "plan_name": "UHC - Adhoc All Payer", "methodology": "case rate", "standard_charge_dollar": 18079.09 }, { "payer_name": "UHC - Adhoc", "plan_name": "UHC - Adhoc Oxford", "methodology": "case rate", "standard_charge_dollar": 15295.44 }, { "payer_name": "Wellcare", "plan_name": "Wellcare Insurance Exchange", "methodology": "case rate", "standard_charge_dollar": 17865.06, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "case rate", "standard_charge_dollar": 10932.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup Medicare", "methodology": "case rate", "standard_charge_dollar": 10932.8, "additional_payer_notes": "100.00% of Medicare Rates" } ] } ] }, { "description": "PERCUTANEOUS CORONARY INTERVENTION W AMI - SOI : 4", "code_information": [ { "code": "1744", "type": "APR-DRG" } ], "standard_charges": [ { "setting": "inpatient", "minimum": 47941.6, "maximum": 52735.76, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Better Health - Medi Medi", "methodology": "case rate", "standard_charge_dollar": 52735.76, "additional_payer_notes": "110% of State Medicaid Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Better Health Medicaid", "methodology": "case rate", "standard_charge_dollar": 52735.76, "additional_payer_notes": "110% of State Medicaid Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "case rate", "standard_charge_dollar": 47941.6, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "UBH", "plan_name": "UBH Medicaid", "methodology": "case rate", "standard_charge_dollar": 47941.6, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicaid (02/01/2023 to 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 48900.43, "additional_payer_notes": "102% of State Medicaid Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicaid", "methodology": "case rate", "standard_charge_dollar": 47941.6, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup Medicaid", "methodology": "case rate", "standard_charge_dollar": 47941.6, "additional_payer_notes": "100% of State Medicaid Rates" } ] } ] }, { "description": "Hc Antibiotic Sens,Mic,Each", "code_information": [ { "code": "87186", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 467.0, "discounted_cash": 8.0, "minimum": 5.19, "maximum": 396.95, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 18.34, "additional_payer_notes": "212.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medical Rental Network", "methodology": "fee schedule", "standard_charge_dollar": 18.34, "additional_payer_notes": "212.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 8.65, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "ALLY-ALIGN (FKA SPARTAN PLAN NJ, INC.)", "plan_name": "ALLY-ALIGN (FKA SPARTAN PLAN NJ, INC.)", "methodology": "fee schedule", "standard_charge_dollar": 9.08, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Americhoice (UHC)", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 8.65, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Amerihealth", "plan_name": "Amerihealth Medicare", "methodology": "fee schedule", "standard_charge_dollar": 8.65, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 12.54, "additional_payer_notes": "Laboratory - 145.00% of Medicare Rates" }, { "payer_name": "Clover Health", "plan_name": "Clover Medicare", "methodology": "fee schedule", "standard_charge_dollar": 8.65, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Coventry", "plan_name": "Coventry Auto", "methodology": "fee schedule", "standard_charge_dollar": 17.3, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Coventry", "plan_name": "Coventry Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 17.3, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "fee schedule", "standard_charge_dollar": 12.11, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Fairprice Healthcare Holdings", "plan_name": "Fairprice Healthcare Holdings", "methodology": "fee schedule", "standard_charge_dollar": 10.38, "additional_payer_notes": "Laboratory - 120.00% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ HMO POS", "methodology": "fee schedule", "standard_charge_dollar": 329.7, "additional_payer_notes": "177.30% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ Indemnity", "methodology": "fee schedule", "standard_charge_dollar": 329.7, "additional_payer_notes": "177.30% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ PPO", "methodology": "fee schedule", "standard_charge_dollar": 329.7, "additional_payer_notes": "177.30% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon Medicare", "methodology": "fee schedule", "standard_charge_dollar": 8.65, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Military Tricare", "methodology": "fee schedule", "standard_charge_dollar": 6.92, "additional_payer_notes": "80.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 8.65, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 8.65, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC All Payer (02-01-2023 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 5.19 }, { "payer_name": "UHC", "plan_name": "UHC Medicaid (02/01/2023 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 6.92 }, { "payer_name": "UHC", "plan_name": "UHC Oxford (02-01-2023 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 5.19 }, { "payer_name": "UHC - Adhoc", "plan_name": "UHC - Adhoc All Payer", "methodology": "fee schedule", "standard_charge_dollar": 8.65 }, { "payer_name": "UHC - Adhoc", "plan_name": "UHC - Adhoc Oxford", "methodology": "fee schedule", "standard_charge_dollar": 8.65 }, { "payer_name": "Wellcare", "plan_name": "Wellcare Insurance Exchange", "methodology": "fee schedule", "standard_charge_dollar": 11.68, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 8.65, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup Medicaid", "methodology": "percent of total billed charges", "standard_charge_percentage": 19.09, "median_amount": 87.1, "10th_percentile": 87.1, "90th_percentile": 87.1, "count": "39" }, { "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup Medicare", "methodology": "fee schedule", "standard_charge_dollar": 8.65, "additional_payer_notes": "100.00% of Medicare Rates" } ] } ] }, { "description": "Hc Remv Rectal Obstr:Feces/F.B. W Anest", "code_information": [ { "code": "45915", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 3652.09, "discounted_cash": 1414.0, "minimum": 697.184, "maximum": 12312.0, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 2999.1, "additional_payer_notes": "212.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medical Rental Network", "methodology": "fee schedule", "standard_charge_dollar": 2999.1, "additional_payer_notes": "212.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1414.67, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "ALLY-ALIGN (FKA SPARTAN PLAN NJ, INC.)", "plan_name": "ALLY-ALIGN (FKA SPARTAN PLAN NJ, INC.)", "methodology": "fee schedule", "standard_charge_dollar": 1485.4, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Americhoice (UHC)", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1414.67, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Amerihealth", "plan_name": "Amerihealth Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1414.67, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 2078.86, "additional_payer_notes": "146.95% of Medicare Rates" }, { "payer_name": "Clover Health", "plan_name": "Clover Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1414.67, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Coventry", "plan_name": "Coventry Auto", "methodology": "fee schedule", "standard_charge_dollar": 2829.34, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Coventry", "plan_name": "Coventry Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 2829.34, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "fee schedule", "standard_charge_dollar": 1980.54, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Fairprice Healthcare Holdings", "plan_name": "Fairprice Healthcare Holdings", "methodology": "fee schedule", "standard_charge_dollar": 2263.47, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ HMO POS", "methodology": "fee schedule", "standard_charge_dollar": 2508.21, "additional_payer_notes": "177.30% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ Indemnity", "methodology": "fee schedule", "standard_charge_dollar": 2508.21, "additional_payer_notes": "177.30% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ PPO", "methodology": "fee schedule", "standard_charge_dollar": 2508.21, "additional_payer_notes": "177.30% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1414.67, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Military Tricare", "methodology": "fee schedule", "standard_charge_dollar": 1131.74, "additional_payer_notes": "80.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1414.67, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 1414.67, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC All Payer (02-01-2023 to 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 3652.09 }, { "payer_name": "UHC", "plan_name": "UHC Oxford (02-01-2023 to 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 3652.09 }, { "payer_name": "UHC - Adhoc", "plan_name": "UHC - Adhoc All Payer", "methodology": "case rate", "standard_charge_dollar": 3652.09 }, { "payer_name": "UHC - Adhoc", "plan_name": "UHC - Adhoc Oxford", "methodology": "case rate", "standard_charge_dollar": 3652.09 }, { "payer_name": "Wellcare", "plan_name": "Wellcare Insurance Exchange", "methodology": "fee schedule", "standard_charge_dollar": 1909.8, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1414.67, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellchoice", "plan_name": "WELLCHOICE HMO of NJ (Empire) Commercial (HMO / HMO POS, PPO)", "methodology": "case rate", "standard_charge_dollar": 1715.0 }, { "payer_name": "Wellchoice", "plan_name": "WELLCHOICE HMO of NJ (Empire) Commercial (Indemnity)", "methodology": "case rate", "standard_charge_dollar": 1978.0 }, { "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1414.67, "additional_payer_notes": "100.00% of Medicare Rates" } ] } ] }, { "description": "OTHER MALE REPRODUCTIVE SYSTEM O.R. PROCEDURES FOR MALIGNANCY WITH CCMCC", "code_information": [ { "code": "715", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 27412.0, "minimum": 13799.35, "maximum": 49615.7381, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "case rate", "standard_charge_dollar": 49615.74, "additional_payer_notes": "181.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medical Rental Network", "methodology": "case rate", "standard_charge_dollar": 49615.74, "additional_payer_notes": "181.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "case rate", "standard_charge_dollar": 22317.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "ALLY-ALIGN (FKA SPARTAN PLAN NJ, INC.)", "plan_name": "ALLY-ALIGN (FKA SPARTAN PLAN NJ, INC.)", "methodology": "case rate", "standard_charge_dollar": 28782.61, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Americhoice (UHC)", "plan_name": "UHC Medicare", "methodology": "case rate", "standard_charge_dollar": 22317.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Amerihealth", "plan_name": "Amerihealth Medicare", "methodology": "case rate", "standard_charge_dollar": 22317.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Commercial", "methodology": "case rate", "standard_charge_dollar": 32731.7 }, { "payer_name": "Clover Health", "plan_name": "Clover Medicare", "methodology": "case rate", "standard_charge_dollar": 22317.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Coventry", "plan_name": "Coventry Auto", "methodology": "case rate", "standard_charge_dollar": 46600.42, "additional_payer_notes": "170.00% of Medicare Rates" }, { "payer_name": "Coventry", "plan_name": "Coventry Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 46600.42, "additional_payer_notes": "170.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "case rate", "standard_charge_dollar": 35635.61, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Fairprice Healthcare Holdings", "plan_name": "Fairprice Healthcare Holdings", "methodology": "case rate", "standard_charge_dollar": 43859.22, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon Medicare", "methodology": "case rate", "standard_charge_dollar": 22317.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon NJ Health Medicaid", "methodology": "case rate", "standard_charge_dollar": 13799.35 }, { "payer_name": "Humana", "plan_name": "Humana Military Tricare", "methodology": "case rate", "standard_charge_dollar": 21929.61, "additional_payer_notes": "80.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 27412.01, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 32855.6 }, { "payer_name": "UBH", "plan_name": "UBH Medicare", "methodology": "case rate", "standard_charge_dollar": 22317.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC All Payer (02-01-2023 to 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 37711.93 }, { "payer_name": "UHC", "plan_name": "UHC Oxford (02-01-2023 to 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 32865.94 }, { "payer_name": "UHC - Adhoc", "plan_name": "UHC - Adhoc All Payer", "methodology": "case rate", "standard_charge_dollar": 40032.01 }, { "payer_name": "UHC - Adhoc", "plan_name": "UHC - Adhoc Oxford", "methodology": "case rate", "standard_charge_dollar": 33868.25 }, { "payer_name": "Wellcare", "plan_name": "Wellcare Insurance Exchange", "methodology": "case rate", "standard_charge_dollar": 37006.21, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "case rate", "standard_charge_dollar": 22317.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup Medicare", "methodology": "case rate", "standard_charge_dollar": 22317.8, "additional_payer_notes": "100.00% of Medicare Rates" } ] } ] }, { "description": "Hc Rmvl Subq Car Rhythm Monitor", "code_information": [ { "code": "33286", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 2896.7, "discounted_cash": 837.0, "minimum": 552.98, "maximum": 3050.05, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 1774.76, "additional_payer_notes": "212.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medical Rental Network", "methodology": "fee schedule", "standard_charge_dollar": 1774.76, "additional_payer_notes": "212.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 837.15, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "ALLY-ALIGN (FKA SPARTAN PLAN NJ, INC.)", "plan_name": "ALLY-ALIGN (FKA SPARTAN PLAN NJ, INC.)", "methodology": "fee schedule", "standard_charge_dollar": 879.01, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Americhoice (UHC)", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 837.15, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Amerihealth", "plan_name": "Amerihealth Medicare", "methodology": "fee schedule", "standard_charge_dollar": 837.15, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 1230.19, "additional_payer_notes": "146.95% of Medicare Rates" }, { "payer_name": "Clover Health", "plan_name": "Clover Medicare", "methodology": "fee schedule", "standard_charge_dollar": 837.15, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Coventry", "plan_name": "Coventry Auto", "methodology": "fee schedule", "standard_charge_dollar": 1674.3, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Coventry", "plan_name": "Coventry Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 1674.3, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "fee schedule", "standard_charge_dollar": 1172.01, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Fairprice Healthcare Holdings", "plan_name": "Fairprice Healthcare Holdings", "methodology": "fee schedule", "standard_charge_dollar": 1339.44, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ HMO POS", "methodology": "fee schedule", "standard_charge_dollar": 1484.27, "additional_payer_notes": "177.30% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ Indemnity", "methodology": "fee schedule", "standard_charge_dollar": 1484.27, "additional_payer_notes": "177.30% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ PPO", "methodology": "fee schedule", "standard_charge_dollar": 1484.27, "additional_payer_notes": "177.30% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon Medicare", "methodology": "fee schedule", "standard_charge_dollar": 837.15, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon NJ Health Medicaid", "methodology": "percent of total billed charges", "standard_charge_percentage": 19.58, "median_amount": 597.2, "10th_percentile": 597.2, "90th_percentile": 597.2, "count": "1 through 10" }, { "payer_name": "Humana", "plan_name": "Humana Military Tricare", "methodology": "fee schedule", "standard_charge_dollar": 669.72, "additional_payer_notes": "80.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 837.15, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 837.15, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC All Payer (02-01-2023 to 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 2896.7 }, { "payer_name": "UHC", "plan_name": "UHC Oxford (02-01-2023 to 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 2297.0 }, { "payer_name": "UHC - Adhoc", "plan_name": "UHC - Adhoc All Payer", "methodology": "case rate", "standard_charge_dollar": 2896.7 }, { "payer_name": "UHC - Adhoc", "plan_name": "UHC - Adhoc Oxford", "methodology": "case rate", "standard_charge_dollar": 2367.0 }, { "payer_name": "Wellcare", "plan_name": "Wellcare Insurance Exchange", "methodology": "fee schedule", "standard_charge_dollar": 1130.15, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 837.15, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellchoice", "plan_name": "WELLCHOICE HMO of NJ (Empire) Commercial (HMO / HMO POS, PPO)", "methodology": "case rate", "standard_charge_dollar": 2472.0 }, { "payer_name": "Wellchoice", "plan_name": "WELLCHOICE HMO of NJ (Empire) Commercial (Indemnity)", "methodology": "case rate", "standard_charge_dollar": 2753.0 }, { "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup Medicare", "methodology": "fee schedule", "standard_charge_dollar": 837.15, "additional_payer_notes": "100.00% of Medicare Rates" } ] } ] }, { "description": "Hc Plc Cath Carot/Vert Art", "code_information": [ { "code": "36100", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 1303.05, "minimum": 248.7522, "maximum": 1303.05, "payers_information": [ { "payer_name": "UHC", "plan_name": "UHC All Payer (02-01-2023 to 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 1303.05 }, { "payer_name": "UHC", "plan_name": "UHC Oxford (02-01-2023 to 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 1303.05 }, { "payer_name": "UHC - Adhoc", "plan_name": "UHC - Adhoc All Payer", "methodology": "case rate", "standard_charge_dollar": 1303.05 }, { "payer_name": "UHC - Adhoc", "plan_name": "UHC - Adhoc Oxford", "methodology": "case rate", "standard_charge_dollar": 1303.05 }, { "payer_name": "Wellchoice", "plan_name": "WELLCHOICE HMO of NJ (Empire) Commercial (HMO / HMO POS, PPO)", "methodology": "case rate", "standard_charge_dollar": 1303.05 }, { "payer_name": "Wellchoice", "plan_name": "WELLCHOICE HMO of NJ (Empire) Commercial (Indemnity)", "methodology": "case rate", "standard_charge_dollar": 1303.05 } ] } ] }, { "description": "Hc Rbc Osmotic Fragility", "code_information": [ { "code": "85555", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 147.0, "discounted_cash": 7.0, "minimum": 4.48, "maximum": 124.95, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 15.84, "additional_payer_notes": "212.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medical Rental Network", "methodology": "fee schedule", "standard_charge_dollar": 15.84, "additional_payer_notes": "212.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 7.47, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "ALLY-ALIGN (FKA SPARTAN PLAN NJ, INC.)", "plan_name": "ALLY-ALIGN (FKA SPARTAN PLAN NJ, INC.)", "methodology": "fee schedule", "standard_charge_dollar": 7.84, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Americhoice (UHC)", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 7.47, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Amerihealth", "plan_name": "Amerihealth Medicare", "methodology": "fee schedule", "standard_charge_dollar": 7.47, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 10.83, "additional_payer_notes": "Laboratory - 145.00% of Medicare Rates" }, { "payer_name": "Clover Health", "plan_name": "Clover Medicare", "methodology": "fee schedule", "standard_charge_dollar": 7.47, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Coventry", "plan_name": "Coventry Auto", "methodology": "fee schedule", "standard_charge_dollar": 14.94, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Coventry", "plan_name": "Coventry Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 14.94, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "fee schedule", "standard_charge_dollar": 10.46, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Fairprice Healthcare Holdings", "plan_name": "Fairprice Healthcare Holdings", "methodology": "fee schedule", "standard_charge_dollar": 8.96, "additional_payer_notes": "Laboratory - 120.00% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ HMO POS", "methodology": "fee schedule", "standard_charge_dollar": 103.78, "additional_payer_notes": "177.30% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ Indemnity", "methodology": "fee schedule", "standard_charge_dollar": 103.78, "additional_payer_notes": "177.30% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ PPO", "methodology": "fee schedule", "standard_charge_dollar": 103.78, "additional_payer_notes": "177.30% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon Medicare", "methodology": "fee schedule", "standard_charge_dollar": 7.47, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Military Tricare", "methodology": "fee schedule", "standard_charge_dollar": 5.98, "additional_payer_notes": "80.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 7.47, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 7.47, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC All Payer (02-01-2023 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 4.48 }, { "payer_name": "UHC", "plan_name": "UHC Medicaid (02/01/2023 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 5.98 }, { "payer_name": "UHC", "plan_name": "UHC Oxford (02-01-2023 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 4.48 }, { "payer_name": "UHC - Adhoc", "plan_name": "UHC - Adhoc All Payer", "methodology": "fee schedule", "standard_charge_dollar": 7.47 }, { "payer_name": "UHC - Adhoc", "plan_name": "UHC - Adhoc Oxford", "methodology": "fee schedule", "standard_charge_dollar": 7.47 }, { "payer_name": "Wellcare", "plan_name": "Wellcare Insurance Exchange", "methodology": "fee schedule", "standard_charge_dollar": 10.08, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 7.47, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup Medicare", "methodology": "fee schedule", "standard_charge_dollar": 7.47, "additional_payer_notes": "100.00% of Medicare Rates" } ] } ] }, { "description": "Hc Repair Lip,Full Thick,Vermilion", "code_information": [ { "code": "40650", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 2258.72, "discounted_cash": 637.0, "minimum": 431.1896, "maximum": 2258.72, "payers_information": [ { "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ Indemnity", "methodology": "fee schedule", "standard_charge_dollar": 1130.45, "additional_payer_notes": "177.30% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ PPO", "methodology": "fee schedule", "standard_charge_dollar": 1130.45, "additional_payer_notes": "177.30% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon Medicare", "methodology": "fee schedule", "standard_charge_dollar": 637.59, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Military Tricare", "methodology": "fee schedule", "standard_charge_dollar": 510.07, "additional_payer_notes": "80.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 637.59, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 637.59, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC All Payer (02-01-2023 to 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 2258.72 }, { "payer_name": "UHC", "plan_name": "UHC Oxford (02-01-2023 to 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 2258.72 }, { "payer_name": "UHC - Adhoc", "plan_name": "UHC - Adhoc All Payer", "methodology": "case rate", "standard_charge_dollar": 2258.72 }, { "payer_name": "UHC - Adhoc", "plan_name": "UHC - Adhoc Oxford", "methodology": "case rate", "standard_charge_dollar": 2258.72 }, { "payer_name": "Wellcare", "plan_name": "Wellcare Insurance Exchange", "methodology": "fee schedule", "standard_charge_dollar": 860.75, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 637.59, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellchoice", "plan_name": "WELLCHOICE HMO of NJ (Empire) Commercial (HMO / HMO POS, PPO)", "methodology": "case rate", "standard_charge_dollar": 1715.0 }, { "payer_name": "Wellchoice", "plan_name": "WELLCHOICE HMO of NJ (Empire) Commercial (Indemnity)", "methodology": "case rate", "standard_charge_dollar": 1978.0 }, { "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup Medicare", "methodology": "fee schedule", "standard_charge_dollar": 637.59, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 1351.69, "additional_payer_notes": "212.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medical Rental Network", "methodology": "fee schedule", "standard_charge_dollar": 1351.69, "additional_payer_notes": "212.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 637.59, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "ALLY-ALIGN (FKA SPARTAN PLAN NJ, INC.)", "plan_name": "ALLY-ALIGN (FKA SPARTAN PLAN NJ, INC.)", "methodology": "fee schedule", "standard_charge_dollar": 669.47, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Americhoice (UHC)", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 637.59, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Amerihealth", "plan_name": "Amerihealth Medicare", "methodology": "fee schedule", "standard_charge_dollar": 637.59, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 936.94, "additional_payer_notes": "146.95% of Medicare Rates" }, { "payer_name": "Clover Health", "plan_name": "Clover Medicare", "methodology": "fee schedule", "standard_charge_dollar": 637.59, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Coventry", "plan_name": "Coventry Auto", "methodology": "fee schedule", "standard_charge_dollar": 1275.18, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Coventry", "plan_name": "Coventry Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 1275.18, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "fee schedule", "standard_charge_dollar": 892.63, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Fairprice Healthcare Holdings", "plan_name": "Fairprice Healthcare Holdings", "methodology": "fee schedule", "standard_charge_dollar": 1020.14, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ HMO POS", "methodology": "fee schedule", "standard_charge_dollar": 1130.45, "additional_payer_notes": "177.30% of Medicare Rates" } ] } ] }, { "description": "Hc Ct Guidance Placement Rad Therapy Fields", "code_information": [ { "code": "77014", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 516.0, "minimum": 98.5044, "maximum": 516.0, "payers_information": [ { "payer_name": "UHC", "plan_name": "UHC All Payer (02-01-2023 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 516.0 }, { "payer_name": "UHC", "plan_name": "UHC Oxford (02-01-2023 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 516.0 }, { "payer_name": "Wellchoice", "plan_name": "WELLCHOICE HMO of NJ (Empire) Commercial (HMO / HMO POS, PPO)", "methodology": "case rate", "standard_charge_dollar": 167.0 }, { "payer_name": "Wellchoice", "plan_name": "WELLCHOICE HMO of NJ (Empire) Commercial (Indemnity)", "methodology": "case rate", "standard_charge_dollar": 202.0 } ] } ] }, { "description": "Biopsy Of Vulva/Perineum", "code_information": [ { "code": "56605", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 15390.0, "discounted_cash": 1088.0, "minimum": 871.096, "maximum": 12312.0, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 2308.4, "additional_payer_notes": "212.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medical Rental Network", "methodology": "fee schedule", "standard_charge_dollar": 2308.4, "additional_payer_notes": "212.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1088.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "ALLY-ALIGN (FKA SPARTAN PLAN NJ, INC.)", "plan_name": "ALLY-ALIGN (FKA SPARTAN PLAN NJ, INC.)", "methodology": "fee schedule", "standard_charge_dollar": 1143.31, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Americhoice (UHC)", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1088.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Amerihealth", "plan_name": "Amerihealth Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1088.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 1600.09, "additional_payer_notes": "146.95% of Medicare Rates" }, { "payer_name": "Clover Health", "plan_name": "Clover Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1088.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Coventry", "plan_name": "Coventry Auto", "methodology": "fee schedule", "standard_charge_dollar": 2177.74, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Coventry", "plan_name": "Coventry Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 2177.74, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "fee schedule", "standard_charge_dollar": 1524.42, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Fairprice Healthcare Holdings", "plan_name": "Fairprice Healthcare Holdings", "methodology": "fee schedule", "standard_charge_dollar": 1742.19, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ HMO POS", "methodology": "fee schedule", "standard_charge_dollar": 1930.57, "additional_payer_notes": "177.30% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ Indemnity", "methodology": "fee schedule", "standard_charge_dollar": 1930.57, "additional_payer_notes": "177.30% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ PPO", "methodology": "fee schedule", "standard_charge_dollar": 1930.57, "additional_payer_notes": "177.30% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1088.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon NJ Health Medicaid", "methodology": "percent of total billed charges", "standard_charge_percentage": 19.58, "median_amount": 753.34, "10th_percentile": 753.34, "90th_percentile": 753.34, "count": "1 through 10" }, { "payer_name": "Humana", "plan_name": "Humana Military Tricare", "methodology": "fee schedule", "standard_charge_dollar": 871.1, "additional_payer_notes": "80.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1088.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 1088.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC All Payer (02-01-2023 to 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 3147.0 }, { "payer_name": "UHC", "plan_name": "UHC Medicaid (02/01/2023 to 12-31-2026)", "methodology": "percent of total billed charges", "standard_charge_percentage": 19.47, "median_amount": 1951.76, "10th_percentile": 1951.76, "90th_percentile": 1951.76, "count": "1 through 10" }, { "payer_name": "UHC", "plan_name": "UHC Oxford (02-01-2023 to 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 2297.0 }, { "payer_name": "UHC - Adhoc", "plan_name": "UHC - Adhoc All Payer", "methodology": "case rate", "standard_charge_dollar": 3341.0 }, { "payer_name": "UHC - Adhoc", "plan_name": "UHC - Adhoc Oxford", "methodology": "case rate", "standard_charge_dollar": 2367.0 }, { "payer_name": "Wellcare", "plan_name": "Wellcare Insurance Exchange", "methodology": "fee schedule", "standard_charge_dollar": 1469.97, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1088.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellchoice", "plan_name": "WELLCHOICE HMO of NJ (Empire) Commercial (HMO / HMO POS, PPO)", "methodology": "case rate", "standard_charge_dollar": 1715.0 }, { "payer_name": "Wellchoice", "plan_name": "WELLCHOICE HMO of NJ (Empire) Commercial (Indemnity)", "methodology": "case rate", "standard_charge_dollar": 1978.0 }, { "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1088.87, "additional_payer_notes": "100.00% of Medicare Rates" } ] } ] }, { "description": "Removal Of Foot Lesion - 28080 - OR36028080", "code_information": [ { "code": "28080", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 26932.5, "discounted_cash": 1900.0, "minimum": 1520.776, "maximum": 21546.0, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 4030.06, "additional_payer_notes": "212.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medical Rental Network", "methodology": "fee schedule", "standard_charge_dollar": 4030.06, "additional_payer_notes": "212.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1900.97, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "ALLY-ALIGN (FKA SPARTAN PLAN NJ, INC.)", "plan_name": "ALLY-ALIGN (FKA SPARTAN PLAN NJ, INC.)", "methodology": "fee schedule", "standard_charge_dollar": 1996.02, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Americhoice (UHC)", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1900.97, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Amerihealth", "plan_name": "Amerihealth Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1900.97, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 2793.48, "additional_payer_notes": "146.95% of Medicare Rates" }, { "payer_name": "Clover Health", "plan_name": "Clover Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1900.97, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Coventry", "plan_name": "Coventry Auto", "methodology": "fee schedule", "standard_charge_dollar": 3801.94, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Coventry", "plan_name": "Coventry Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 3801.94, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "fee schedule", "standard_charge_dollar": 2661.36, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Fairprice Healthcare Holdings", "plan_name": "Fairprice Healthcare Holdings", "methodology": "fee schedule", "standard_charge_dollar": 3041.55, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ HMO POS", "methodology": "fee schedule", "standard_charge_dollar": 3370.42, "additional_payer_notes": "177.30% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ Indemnity", "methodology": "fee schedule", "standard_charge_dollar": 3370.42, "additional_payer_notes": "177.30% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ PPO", "methodology": "fee schedule", "standard_charge_dollar": 3370.42, "additional_payer_notes": "177.30% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1900.97, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Military Tricare", "methodology": "fee schedule", "standard_charge_dollar": 1520.78, "additional_payer_notes": "80.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1900.97, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 1900.97, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC All Payer (02-01-2023 to 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 4415.0 }, { "payer_name": "UHC", "plan_name": "UHC Oxford (02-01-2023 to 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 4020.0 }, { "payer_name": "UHC - Adhoc", "plan_name": "UHC - Adhoc All Payer", "methodology": "case rate", "standard_charge_dollar": 4687.0 }, { "payer_name": "UHC - Adhoc", "plan_name": "UHC - Adhoc Oxford", "methodology": "case rate", "standard_charge_dollar": 4143.0 }, { "payer_name": "Wellcare", "plan_name": "Wellcare Insurance Exchange", "methodology": "fee schedule", "standard_charge_dollar": 2566.31, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1900.97, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellchoice", "plan_name": "WELLCHOICE HMO of NJ (Empire) Commercial (HMO / HMO POS, PPO)", "methodology": "case rate", "standard_charge_dollar": 1715.0 }, { "payer_name": "Wellchoice", "plan_name": "WELLCHOICE HMO of NJ (Empire) Commercial (Indemnity)", "methodology": "case rate", "standard_charge_dollar": 1978.0 }, { "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1900.97, "additional_payer_notes": "100.00% of Medicare Rates" } ] } ] }, { "description": "Hc App Skn Sub Head/Hnd/Ft/Gnt Ttl 100Sqcm Ea Ad 25Cm", "code_information": [ { "code": "15276", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 2196.5, "minimum": 419.3118, "maximum": 2196.5, "payers_information": [ { "payer_name": "UHC", "plan_name": "UHC All Payer (02-01-2023 to 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 2196.5 }, { "payer_name": "UHC", "plan_name": "UHC Oxford (02-01-2023 to 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 2196.5 }, { "payer_name": "UHC - Adhoc", "plan_name": "UHC - Adhoc All Payer", "methodology": "case rate", "standard_charge_dollar": 2196.5 }, { "payer_name": "UHC - Adhoc", "plan_name": "UHC - Adhoc Oxford", "methodology": "case rate", "standard_charge_dollar": 2196.5 }, { "payer_name": "Wellchoice", "plan_name": "WELLCHOICE HMO of NJ (Empire) Commercial (HMO / HMO POS, PPO)", "methodology": "case rate", "standard_charge_dollar": 1715.0 }, { "payer_name": "Wellchoice", "plan_name": "WELLCHOICE HMO of NJ (Empire) Commercial (Indemnity)", "methodology": "case rate", "standard_charge_dollar": 1978.0 } ] } ] }, { "description": "Hc Blood Count Manual Difrntl Wbc Count Buffy Coat", "code_information": [ { "code": "85009", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 26.0, "discounted_cash": 5.0, "minimum": 3.04, "maximum": 22.1, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 10.75, "additional_payer_notes": "212.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medical Rental Network", "methodology": "fee schedule", "standard_charge_dollar": 10.75, "additional_payer_notes": "212.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5.07, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "ALLY-ALIGN (FKA SPARTAN PLAN NJ, INC.)", "plan_name": "ALLY-ALIGN (FKA SPARTAN PLAN NJ, INC.)", "methodology": "fee schedule", "standard_charge_dollar": 5.32, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Americhoice (UHC)", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5.07, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Amerihealth", "plan_name": "Amerihealth Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5.07, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 7.35, "additional_payer_notes": "Laboratory - 145.00% of Medicare Rates" }, { "payer_name": "Clover Health", "plan_name": "Clover Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5.07, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Coventry", "plan_name": "Coventry Auto", "methodology": "fee schedule", "standard_charge_dollar": 10.14, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Coventry", "plan_name": "Coventry Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 10.14, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "fee schedule", "standard_charge_dollar": 7.1, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Fairprice Healthcare Holdings", "plan_name": "Fairprice Healthcare Holdings", "methodology": "fee schedule", "standard_charge_dollar": 6.08, "additional_payer_notes": "Laboratory - 120.00% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ HMO POS", "methodology": "fee schedule", "standard_charge_dollar": 18.36, "additional_payer_notes": "177.30% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ Indemnity", "methodology": "fee schedule", "standard_charge_dollar": 18.36, "additional_payer_notes": "177.30% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ PPO", "methodology": "fee schedule", "standard_charge_dollar": 18.36, "additional_payer_notes": "177.30% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5.07, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Military Tricare", "methodology": "fee schedule", "standard_charge_dollar": 4.06, "additional_payer_notes": "80.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5.07, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 5.07, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC All Payer (02-01-2023 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 3.04 }, { "payer_name": "UHC", "plan_name": "UHC Medicaid (02/01/2023 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 4.06 }, { "payer_name": "UHC", "plan_name": "UHC Oxford (02-01-2023 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 3.04 }, { "payer_name": "UHC - Adhoc", "plan_name": "UHC - Adhoc All Payer", "methodology": "fee schedule", "standard_charge_dollar": 5.07 }, { "payer_name": "UHC - Adhoc", "plan_name": "UHC - Adhoc Oxford", "methodology": "fee schedule", "standard_charge_dollar": 5.07 }, { "payer_name": "Wellcare", "plan_name": "Wellcare Insurance Exchange", "methodology": "fee schedule", "standard_charge_dollar": 6.84, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5.07, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5.07, "additional_payer_notes": "100.00% of Medicare Rates" } ] } ] }, { "description": "Rpr Aa Hrn 1St > 10 Rdc", "code_information": [ { "code": "49595", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 75731.3, "discounted_cash": 7653.0, "minimum": 1715.0, "maximum": 60585.04, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 16225.17, "additional_payer_notes": "212.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medical Rental Network", "methodology": "fee schedule", "standard_charge_dollar": 16225.17, "additional_payer_notes": "212.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 7653.38, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "ALLY-ALIGN (FKA SPARTAN PLAN NJ, INC.)", "plan_name": "ALLY-ALIGN (FKA SPARTAN PLAN NJ, INC.)", "methodology": "fee schedule", "standard_charge_dollar": 8036.05, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Americhoice (UHC)", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 7653.38, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Amerihealth", "plan_name": "Amerihealth Medicare", "methodology": "fee schedule", "standard_charge_dollar": 7653.38, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 11246.64, "additional_payer_notes": "146.95% of Medicare Rates" }, { "payer_name": "Clover Health", "plan_name": "Clover Medicare", "methodology": "fee schedule", "standard_charge_dollar": 7653.38, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Coventry", "plan_name": "Coventry Auto", "methodology": "fee schedule", "standard_charge_dollar": 15306.76, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Coventry", "plan_name": "Coventry Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 15306.76, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "fee schedule", "standard_charge_dollar": 10714.73, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Fairprice Healthcare Holdings", "plan_name": "Fairprice Healthcare Holdings", "methodology": "fee schedule", "standard_charge_dollar": 12245.41, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ HMO POS", "methodology": "fee schedule", "standard_charge_dollar": 13569.44, "additional_payer_notes": "177.30% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ Indemnity", "methodology": "fee schedule", "standard_charge_dollar": 13569.44, "additional_payer_notes": "177.30% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ PPO", "methodology": "fee schedule", "standard_charge_dollar": 13569.44, "additional_payer_notes": "177.30% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon Medicare", "methodology": "fee schedule", "standard_charge_dollar": 7653.38, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Military Tricare", "methodology": "fee schedule", "standard_charge_dollar": 6122.7, "additional_payer_notes": "80.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 7653.38, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 7653.38, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC All Payer (02-01-2023 to 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 5378.0 }, { "payer_name": "UHC", "plan_name": "UHC Oxford (02-01-2023 to 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 5169.0 }, { "payer_name": "UHC - Adhoc", "plan_name": "UHC - Adhoc All Payer", "methodology": "case rate", "standard_charge_dollar": 5709.0 }, { "payer_name": "UHC - Adhoc", "plan_name": "UHC - Adhoc Oxford", "methodology": "case rate", "standard_charge_dollar": 5327.0 }, { "payer_name": "Wellcare", "plan_name": "Wellcare Insurance Exchange", "methodology": "fee schedule", "standard_charge_dollar": 10332.06, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 7653.38, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellchoice", "plan_name": "WELLCHOICE HMO of NJ (Empire) Commercial (HMO / HMO POS, PPO)", "methodology": "case rate", "standard_charge_dollar": 1715.0 }, { "payer_name": "Wellchoice", "plan_name": "WELLCHOICE HMO of NJ (Empire) Commercial (Indemnity)", "methodology": "case rate", "standard_charge_dollar": 1978.0 }, { "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup Medicare", "methodology": "fee schedule", "standard_charge_dollar": 7653.38, "additional_payer_notes": "100.00% of Medicare Rates" } ] } ] }, { "description": "EPISTAXIS WITH MCC", "code_information": [ { "code": "150", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 16944.0, "minimum": 8289.35, "maximum": 30668.9296, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "case rate", "standard_charge_dollar": 30668.93, "additional_payer_notes": "181.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medical Rental Network", "methodology": "case rate", "standard_charge_dollar": 30668.93, "additional_payer_notes": "181.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "case rate", "standard_charge_dollar": 13912.4, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "ALLY-ALIGN (FKA SPARTAN PLAN NJ, INC.)", "plan_name": "ALLY-ALIGN (FKA SPARTAN PLAN NJ, INC.)", "methodology": "case rate", "standard_charge_dollar": 17791.37, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Americhoice (UHC)", "plan_name": "UHC Medicare", "methodology": "case rate", "standard_charge_dollar": 13912.4, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Amerihealth", "plan_name": "Amerihealth Medicare", "methodology": "case rate", "standard_charge_dollar": 13912.4, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Commercial", "methodology": "case rate", "standard_charge_dollar": 19479.85 }, { "payer_name": "Clover Health", "plan_name": "Clover Medicare", "methodology": "case rate", "standard_charge_dollar": 13912.4, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Coventry", "plan_name": "Coventry Auto", "methodology": "case rate", "standard_charge_dollar": 28805.07, "additional_payer_notes": "170.00% of Medicare Rates" }, { "payer_name": "Coventry", "plan_name": "Coventry Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 28805.07, "additional_payer_notes": "170.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "case rate", "standard_charge_dollar": 22027.41, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Fairprice Healthcare Holdings", "plan_name": "Fairprice Healthcare Holdings", "methodology": "case rate", "standard_charge_dollar": 27110.66, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon Medicare", "methodology": "case rate", "standard_charge_dollar": 13912.4, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon NJ Health Medicaid", "methodology": "case rate", "standard_charge_dollar": 8289.35 }, { "payer_name": "Humana", "plan_name": "Humana Military Tricare", "methodology": "case rate", "standard_charge_dollar": 13555.33, "additional_payer_notes": "80.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 16944.16, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 20108.9 }, { "payer_name": "UBH", "plan_name": "UBH Medicare", "methodology": "case rate", "standard_charge_dollar": 13912.4, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC All Payer (02-01-2023 to 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 22443.76 }, { "payer_name": "UHC", "plan_name": "UHC Oxford (02-01-2023 to 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 19559.74 }, { "payer_name": "UHC - Adhoc", "plan_name": "UHC - Adhoc All Payer", "methodology": "case rate", "standard_charge_dollar": 23824.53 }, { "payer_name": "UHC - Adhoc", "plan_name": "UHC - Adhoc Oxford", "methodology": "case rate", "standard_charge_dollar": 20156.25 }, { "payer_name": "Wellcare", "plan_name": "Wellcare Insurance Exchange", "methodology": "case rate", "standard_charge_dollar": 22874.62, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "case rate", "standard_charge_dollar": 13912.4, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup Medicare", "methodology": "case rate", "standard_charge_dollar": 13912.4, "additional_payer_notes": "100.00% of Medicare Rates" } ] } ] }, { "description": "Hc Drug Screening Pregabalin - 80366 - 30180366", "code_information": [ { "code": "80366", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 206.22, "minimum": 16.48, "maximum": 175.287, "payers_information": [ { "payer_name": "UHC", "plan_name": "UHC Medicaid (02/01/2023 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 16.48 } ] } ] }, { "description": "MAJOR RESPIRATORY & CHEST PROCEDURES - SOI : 1", "code_information": [ { "code": "1201", "type": "APR-DRG" } ], "standard_charges": [ { "setting": "inpatient", "minimum": 23491.25, "maximum": 25840.38, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Better Health - Medi Medi", "methodology": "case rate", "standard_charge_dollar": 25840.38, "additional_payer_notes": "110% of State Medicaid Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Better Health Medicaid", "methodology": "case rate", "standard_charge_dollar": 25840.38, "additional_payer_notes": "110% of State Medicaid Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "case rate", "standard_charge_dollar": 23491.25, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "UBH", "plan_name": "UBH Medicaid", "methodology": "case rate", "standard_charge_dollar": 23491.25, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicaid (02/01/2023 to 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 23961.08, "additional_payer_notes": "102% of State Medicaid Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicaid", "methodology": "case rate", "standard_charge_dollar": 23491.25, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup Medicaid", "methodology": "case rate", "standard_charge_dollar": 23491.25, "additional_payer_notes": "100% of State Medicaid Rates" } ] } ] }, { "description": "Hc Drug Screening Pregabalin - G0480 - 30180366", "code_information": [ { "code": "G0480", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 206.22, "discounted_cash": 114.0, "minimum": 8.3996, "maximum": 754.8, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 206.22, "additional_payer_notes": "212.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medical Rental Network", "methodology": "fee schedule", "standard_charge_dollar": 206.22, "additional_payer_notes": "212.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 114.43, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "ALLY-ALIGN (FKA SPARTAN PLAN NJ, INC.)", "plan_name": "ALLY-ALIGN (FKA SPARTAN PLAN NJ, INC.)", "methodology": "fee schedule", "standard_charge_dollar": 120.15, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Americhoice (UHC)", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 114.43, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Amerihealth", "plan_name": "Amerihealth Medicare", "methodology": "fee schedule", "standard_charge_dollar": 114.43, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 165.92, "additional_payer_notes": "Laboratory - 145.00% of Medicare Rates" }, { "payer_name": "Clover Health", "plan_name": "Clover Medicare", "methodology": "fee schedule", "standard_charge_dollar": 114.43, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Coventry", "plan_name": "Coventry Auto", "methodology": "fee schedule", "standard_charge_dollar": 206.22, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Coventry", "plan_name": "Coventry Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 206.22, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "fee schedule", "standard_charge_dollar": 160.2, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Fairprice Healthcare Holdings", "plan_name": "Fairprice Healthcare Holdings", "methodology": "fee schedule", "standard_charge_dollar": 137.32, "additional_payer_notes": "Laboratory - 120.00% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ HMO POS", "methodology": "fee schedule", "standard_charge_dollar": 145.59, "additional_payer_notes": "177.30% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ Indemnity", "methodology": "fee schedule", "standard_charge_dollar": 145.59, "additional_payer_notes": "177.30% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ PPO", "methodology": "fee schedule", "standard_charge_dollar": 145.59, "additional_payer_notes": "177.30% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon Medicare", "methodology": "fee schedule", "standard_charge_dollar": 114.43, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Military Tricare", "methodology": "fee schedule", "standard_charge_dollar": 91.54, "additional_payer_notes": "80.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 114.43, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 114.43, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC All Payer (02-01-2023 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 68.66 }, { "payer_name": "UHC", "plan_name": "UHC Medicaid (02/01/2023 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 91.54 }, { "payer_name": "UHC", "plan_name": "UHC Oxford (02-01-2023 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 68.66 }, { "payer_name": "UHC - Adhoc", "plan_name": "UHC - Adhoc All Payer", "methodology": "fee schedule", "standard_charge_dollar": 114.43 }, { "payer_name": "UHC - Adhoc", "plan_name": "UHC - Adhoc Oxford", "methodology": "fee schedule", "standard_charge_dollar": 114.43 }, { "payer_name": "Wellcare", "plan_name": "Wellcare Insurance Exchange", "methodology": "fee schedule", "standard_charge_dollar": 154.48, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 114.43, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup Medicare", "methodology": "fee schedule", "standard_charge_dollar": 114.43, "additional_payer_notes": "100.00% of Medicare Rates" } ] } ] }, { "description": "Hc Initial Hospital Care/Day 30 Minutes", "code_information": [ { "code": "99221", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 243.0, "minimum": 46.3887, "maximum": 206.55, "payers_information": [ { "payer_name": "Amerihealth", "plan_name": "Amerihealth HMO", "methodology": "fee schedule", "standard_charge_dollar": 85.4 }, { "payer_name": "Amerihealth", "plan_name": "Amerihealth Medicare", "methodology": "fee schedule", "standard_charge_dollar": 85.4, "additional_payer_notes": "100.00% of Medicare Rates" } ] } ] }, { "description": "Hc Angrph Cath F-Up Std Tcat Othr Than Thrombylsis", "code_information": [ { "code": "75898", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 5468.15, "discounted_cash": 3732.0, "minimum": 220.84, "maximum": 5468.15, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 5468.15, "additional_payer_notes": "212.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medical Rental Network", "methodology": "fee schedule", "standard_charge_dollar": 5468.15, "additional_payer_notes": "212.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3732.79, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "ALLY-ALIGN (FKA SPARTAN PLAN NJ, INC.)", "plan_name": "ALLY-ALIGN (FKA SPARTAN PLAN NJ, INC.)", "methodology": "fee schedule", "standard_charge_dollar": 3919.43, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Americhoice (UHC)", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3732.79, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Amerihealth", "plan_name": "Amerihealth HMO", "methodology": "fee schedule", "standard_charge_dollar": 220.84 }, { "payer_name": "Amerihealth", "plan_name": "Amerihealth Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3732.79, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 5468.15, "additional_payer_notes": "146.95% of Medicare Rates" }, { "payer_name": "Clover Health", "plan_name": "Clover Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3732.79, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Coventry", "plan_name": "Coventry Auto", "methodology": "fee schedule", "standard_charge_dollar": 5468.15, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Coventry", "plan_name": "Coventry Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 5468.15, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "fee schedule", "standard_charge_dollar": 5225.91, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Fairprice Healthcare Holdings", "plan_name": "Fairprice Healthcare Holdings", "methodology": "fee schedule", "standard_charge_dollar": 5468.15, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ HMO POS", "methodology": "fee schedule", "standard_charge_dollar": 5468.15, "additional_payer_notes": "177.30% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ Indemnity", "methodology": "fee schedule", "standard_charge_dollar": 5468.15, "additional_payer_notes": "177.30% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ PPO", "methodology": "fee schedule", "standard_charge_dollar": 5468.15, "additional_payer_notes": "177.30% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3732.79, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Military Tricare", "methodology": "fee schedule", "standard_charge_dollar": 2986.23, "additional_payer_notes": "80.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3732.79, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 3732.79, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC All Payer (02-01-2023 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 4292.49 }, { "payer_name": "UHC", "plan_name": "UHC Oxford (02-01-2023 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 4292.49 }, { "payer_name": "UHC - Adhoc", "plan_name": "UHC - Adhoc All Payer", "methodology": "fee schedule", "standard_charge_dollar": 2861.66 }, { "payer_name": "UHC - Adhoc", "plan_name": "UHC - Adhoc Oxford", "methodology": "fee schedule", "standard_charge_dollar": 2861.66 }, { "payer_name": "Wellcare", "plan_name": "Wellcare Insurance Exchange", "methodology": "fee schedule", "standard_charge_dollar": 5039.27, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3732.79, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3732.79, "additional_payer_notes": "100.00% of Medicare Rates" } ] } ] }, { "description": "RENAL FAILURE WITHOUT CCMCC", "code_information": [ { "code": "684", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 8494.0, "minimum": 3870.24, "maximum": 15374.2667, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "case rate", "standard_charge_dollar": 15374.27, "additional_payer_notes": "181.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medical Rental Network", "methodology": "case rate", "standard_charge_dollar": 15374.27, "additional_payer_notes": "181.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "case rate", "standard_charge_dollar": 7127.22, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "ALLY-ALIGN (FKA SPARTAN PLAN NJ, INC.)", "plan_name": "ALLY-ALIGN (FKA SPARTAN PLAN NJ, INC.)", "methodology": "case rate", "standard_charge_dollar": 8918.77, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Americhoice (UHC)", "plan_name": "UHC Medicare", "methodology": "case rate", "standard_charge_dollar": 7127.22, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Amerihealth", "plan_name": "Amerihealth Medicare", "methodology": "case rate", "standard_charge_dollar": 7127.22, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Commercial", "methodology": "case rate", "standard_charge_dollar": 8782.39 }, { "payer_name": "Clover Health", "plan_name": "Clover Medicare", "methodology": "case rate", "standard_charge_dollar": 7127.22, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Coventry", "plan_name": "Coventry Auto", "methodology": "case rate", "standard_charge_dollar": 14439.92, "additional_payer_notes": "170.00% of Medicare Rates" }, { "payer_name": "Coventry", "plan_name": "Coventry Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 14439.92, "additional_payer_notes": "170.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "case rate", "standard_charge_dollar": 11042.29, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Fairprice Healthcare Holdings", "plan_name": "Fairprice Healthcare Holdings", "methodology": "case rate", "standard_charge_dollar": 13590.51, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon Medicare", "methodology": "case rate", "standard_charge_dollar": 7127.22, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon NJ Health Medicaid", "methodology": "case rate", "standard_charge_dollar": 3870.24 }, { "payer_name": "Humana", "plan_name": "Humana Military Tricare", "methodology": "case rate", "standard_charge_dollar": 6795.26, "additional_payer_notes": "80.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 8494.07, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 6166.89 }, { "payer_name": "UBH", "plan_name": "UBH Medicare", "methodology": "case rate", "standard_charge_dollar": 7127.22, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC All Payer (02-01-2023 to 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 10118.66 }, { "payer_name": "UHC", "plan_name": "UHC Oxford (02-01-2023 to 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 8818.41 }, { "payer_name": "UHC - Adhoc", "plan_name": "UHC - Adhoc All Payer", "methodology": "case rate", "standard_charge_dollar": 10741.17 }, { "payer_name": "UHC - Adhoc", "plan_name": "UHC - Adhoc Oxford", "methodology": "case rate", "standard_charge_dollar": 9087.34 }, { "payer_name": "Wellcare", "plan_name": "Wellcare Insurance Exchange", "methodology": "case rate", "standard_charge_dollar": 11466.99, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "case rate", "standard_charge_dollar": 7127.22, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup Medicare", "methodology": "case rate", "standard_charge_dollar": 7127.22, "additional_payer_notes": "100.00% of Medicare Rates" } ] } ] }, { "description": "Hc Inj, Therap/Proph/Diagn, Intra-Arterial", "code_information": [ { "code": "96373", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 1021.1, "discounted_cash": 251.0, "minimum": 194.928, "maximum": 1021.1, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 533.07, "additional_payer_notes": "212.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medical Rental Network", "methodology": "fee schedule", "standard_charge_dollar": 533.07, "additional_payer_notes": "212.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 251.45, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "ALLY-ALIGN (FKA SPARTAN PLAN NJ, INC.)", "plan_name": "ALLY-ALIGN (FKA SPARTAN PLAN NJ, INC.)", "methodology": "fee schedule", "standard_charge_dollar": 264.02, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Americhoice (UHC)", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 251.45, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Amerihealth", "plan_name": "Amerihealth Medicare", "methodology": "fee schedule", "standard_charge_dollar": 251.45, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Clover Health", "plan_name": "Clover Medicare", "methodology": "fee schedule", "standard_charge_dollar": 251.45, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Coventry", "plan_name": "Coventry Auto", "methodology": "fee schedule", "standard_charge_dollar": 502.9, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Coventry", "plan_name": "Coventry Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 502.9, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "fee schedule", "standard_charge_dollar": 352.03, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Fairprice Healthcare Holdings", "plan_name": "Fairprice Healthcare Holdings", "methodology": "fee schedule", "standard_charge_dollar": 402.32, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ HMO POS", "methodology": "fee schedule", "standard_charge_dollar": 445.82, "additional_payer_notes": "177.30% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ Indemnity", "methodology": "fee schedule", "standard_charge_dollar": 445.82, "additional_payer_notes": "177.30% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ PPO", "methodology": "fee schedule", "standard_charge_dollar": 445.82, "additional_payer_notes": "177.30% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon Medicare", "methodology": "fee schedule", "standard_charge_dollar": 251.45, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Military Tricare", "methodology": "fee schedule", "standard_charge_dollar": 201.16, "additional_payer_notes": "80.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 251.45, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 251.45, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC All Payer (02-01-2023 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 1021.1 }, { "payer_name": "UHC", "plan_name": "UHC Oxford (02-01-2023 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 1021.1 }, { "payer_name": "UHC - Adhoc", "plan_name": "UHC - Adhoc All Payer", "methodology": "fee schedule", "standard_charge_dollar": 1021.1 }, { "payer_name": "UHC - Adhoc", "plan_name": "UHC - Adhoc Oxford", "methodology": "fee schedule", "standard_charge_dollar": 1021.1 }, { "payer_name": "Wellcare", "plan_name": "Wellcare Insurance Exchange", "methodology": "fee schedule", "standard_charge_dollar": 339.46, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 251.45, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup Medicare", "methodology": "fee schedule", "standard_charge_dollar": 251.45, "additional_payer_notes": "100.00% of Medicare Rates" } ] } ] }, { "description": "Hc Percutaneous Transluminal Coronary Lithotripsy", "code_information": [ { "code": "92972", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 705.65, "minimum": 134.7086, "maximum": 705.65, "payers_information": [ { "payer_name": "Wellchoice", "plan_name": "WELLCHOICE HMO of NJ (Empire) Commercial (HMO / HMO POS, PPO)", "methodology": "case rate", "standard_charge_dollar": 705.65 }, { "payer_name": "Wellchoice", "plan_name": "WELLCHOICE HMO of NJ (Empire) Commercial (Indemnity)", "methodology": "case rate", "standard_charge_dollar": 705.65 } ] } ] }, { "description": "OTHER MALE REPRODUCTIVE SYSTEM DIAGNOSES WITH CCMCC", "code_information": [ { "code": "729", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 13791.0, "minimum": 6756.37, "maximum": 24962.7055, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "case rate", "standard_charge_dollar": 24962.71, "additional_payer_notes": "181.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medical Rental Network", "methodology": "case rate", "standard_charge_dollar": 24962.71, "additional_payer_notes": "181.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "case rate", "standard_charge_dollar": 11381.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "ALLY-ALIGN (FKA SPARTAN PLAN NJ, INC.)", "plan_name": "ALLY-ALIGN (FKA SPARTAN PLAN NJ, INC.)", "methodology": "case rate", "standard_charge_dollar": 14481.13, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Americhoice (UHC)", "plan_name": "UHC Medicare", "methodology": "case rate", "standard_charge_dollar": 11381.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Amerihealth", "plan_name": "Amerihealth Medicare", "methodology": "case rate", "standard_charge_dollar": 11381.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Commercial", "methodology": "case rate", "standard_charge_dollar": 15488.78 }, { "payer_name": "Clover Health", "plan_name": "Clover Medicare", "methodology": "case rate", "standard_charge_dollar": 11381.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Coventry", "plan_name": "Coventry Auto", "methodology": "case rate", "standard_charge_dollar": 23445.64, "additional_payer_notes": "170.00% of Medicare Rates" }, { "payer_name": "Coventry", "plan_name": "Coventry Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 23445.64, "additional_payer_notes": "170.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "case rate", "standard_charge_dollar": 17929.02, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Fairprice Healthcare Holdings", "plan_name": "Fairprice Healthcare Holdings", "methodology": "case rate", "standard_charge_dollar": 22066.48, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon Medicare", "methodology": "case rate", "standard_charge_dollar": 11381.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon NJ Health Medicaid", "methodology": "case rate", "standard_charge_dollar": 6756.37 }, { "payer_name": "Humana", "plan_name": "Humana Military Tricare", "methodology": "case rate", "standard_charge_dollar": 11033.24, "additional_payer_notes": "80.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 13791.55, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 16016.9 }, { "payer_name": "UBH", "plan_name": "UBH Medicare", "methodology": "case rate", "standard_charge_dollar": 11381.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC All Payer (02-01-2023 to 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 17845.45 }, { "payer_name": "UHC", "plan_name": "UHC Oxford (02-01-2023 to 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 15552.3 }, { "payer_name": "UHC - Adhoc", "plan_name": "UHC - Adhoc All Payer", "methodology": "case rate", "standard_charge_dollar": 18943.32 }, { "payer_name": "UHC - Adhoc", "plan_name": "UHC - Adhoc Oxford", "methodology": "case rate", "standard_charge_dollar": 16026.6 }, { "payer_name": "Wellcare", "plan_name": "Wellcare Insurance Exchange", "methodology": "case rate", "standard_charge_dollar": 18618.59, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "case rate", "standard_charge_dollar": 11381.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup Medicare", "methodology": "case rate", "standard_charge_dollar": 11381.0, "additional_payer_notes": "100.00% of Medicare Rates" } ] } ] }, { "description": "Hc X-Ray Abdomen,Comp Acute Series", "code_information": [ { "code": "74022", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 618.63, "discounted_cash": 123.0, "minimum": 70.93, "maximum": 525.8355, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 262.01, "additional_payer_notes": "212.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medical Rental Network", "methodology": "fee schedule", "standard_charge_dollar": 262.01, "additional_payer_notes": "212.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 123.59, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "ALLY-ALIGN (FKA SPARTAN PLAN NJ, INC.)", "plan_name": "ALLY-ALIGN (FKA SPARTAN PLAN NJ, INC.)", "methodology": "fee schedule", "standard_charge_dollar": 129.77, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Americhoice (UHC)", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 123.59, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Amerihealth", "plan_name": "Amerihealth HMO", "methodology": "fee schedule", "standard_charge_dollar": 70.93 }, { "payer_name": "Amerihealth", "plan_name": "Amerihealth Medicare", "methodology": "fee schedule", "standard_charge_dollar": 123.59, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 181.62, "additional_payer_notes": "146.95% of Medicare Rates" }, { "payer_name": "Clover Health", "plan_name": "Clover Medicare", "methodology": "fee schedule", "standard_charge_dollar": 123.59, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Coventry", "plan_name": "Coventry Auto", "methodology": "fee schedule", "standard_charge_dollar": 247.18, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Coventry", "plan_name": "Coventry Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 247.18, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "fee schedule", "standard_charge_dollar": 173.03, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Fairprice Healthcare Holdings", "plan_name": "Fairprice Healthcare Holdings", "methodology": "fee schedule", "standard_charge_dollar": 197.74, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ HMO POS", "methodology": "fee schedule", "standard_charge_dollar": 219.13, "additional_payer_notes": "177.30% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ Indemnity", "methodology": "fee schedule", "standard_charge_dollar": 219.13, "additional_payer_notes": "177.30% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ PPO", "methodology": "fee schedule", "standard_charge_dollar": 219.13, "additional_payer_notes": "177.30% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon Medicare", "methodology": "fee schedule", "standard_charge_dollar": 123.59, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon NJ Health Medicaid", "methodology": "percent of total billed charges", "standard_charge_percentage": 19.58, "median_amount": 121.13, "10th_percentile": 121.13, "90th_percentile": 121.13, "count": "18" }, { "payer_name": "Humana", "plan_name": "Humana Military Tricare", "methodology": "fee schedule", "standard_charge_dollar": 98.87, "additional_payer_notes": "80.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 123.59, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 123.59, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC All Payer (02-01-2023 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 163.46 }, { "payer_name": "UHC", "plan_name": "UHC Medicaid (02/01/2023 to 12-31-2026)", "methodology": "percent of total billed charges", "standard_charge_percentage": 19.47, "median_amount": 117.68, "10th_percentile": 117.68, "90th_percentile": 117.68, "count": "1 through 10" }, { "payer_name": "UHC", "plan_name": "UHC Oxford (02-01-2023 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 163.46 }, { "payer_name": "UHC - Adhoc", "plan_name": "UHC - Adhoc All Payer", "methodology": "fee schedule", "standard_charge_dollar": 108.97 }, { "payer_name": "UHC - Adhoc", "plan_name": "UHC - Adhoc Oxford", "methodology": "fee schedule", "standard_charge_dollar": 108.97 }, { "payer_name": "Wellcare", "plan_name": "Wellcare Insurance Exchange", "methodology": "fee schedule", "standard_charge_dollar": 166.85, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 123.59, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup Medicaid", "methodology": "percent of total billed charges", "standard_charge_percentage": 19.09, "median_amount": 115.37, "10th_percentile": 115.37, "90th_percentile": 118.1, "count": "1 through 10" }, { "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup Medicare", "methodology": "fee schedule", "standard_charge_dollar": 123.59, "additional_payer_notes": "100.00% of Medicare Rates" } ] } ] }, { "description": "URINARY STONES WITH MCC", "code_information": [ { "code": "693", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 17094.0, "minimum": 8265.0, "maximum": 30940.8459, "payers_information": [ { "payer_name": "Americhoice (UHC)", "plan_name": "UHC Medicare", "methodology": "case rate", "standard_charge_dollar": 14033.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Amerihealth", "plan_name": "Amerihealth Medicare", "methodology": "case rate", "standard_charge_dollar": 14033.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Commercial", "methodology": "case rate", "standard_charge_dollar": 19670.04 }, { "payer_name": "Clover Health", "plan_name": "Clover Medicare", "methodology": "case rate", "standard_charge_dollar": 14033.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Coventry", "plan_name": "Coventry Auto", "methodology": "case rate", "standard_charge_dollar": 29060.46, "additional_payer_notes": "170.00% of Medicare Rates" }, { "payer_name": "Coventry", "plan_name": "Coventry Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 29060.46, "additional_payer_notes": "170.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "case rate", "standard_charge_dollar": 22222.71, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Fairprice Healthcare Holdings", "plan_name": "Fairprice Healthcare Holdings", "methodology": "case rate", "standard_charge_dollar": 27351.02, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon Medicare", "methodology": "case rate", "standard_charge_dollar": 14033.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon NJ Health Medicaid", "methodology": "case rate", "standard_charge_dollar": 8265.0 }, { "payer_name": "Humana", "plan_name": "Humana Military Tricare", "methodology": "case rate", "standard_charge_dollar": 13675.51, "additional_payer_notes": "80.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 17094.39, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 15183.3 }, { "payer_name": "UBH", "plan_name": "UBH Medicare", "methodology": "case rate", "standard_charge_dollar": 14033.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC All Payer (02-01-2023 to 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 22662.89 }, { "payer_name": "UHC", "plan_name": "UHC Oxford (02-01-2023 to 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 19750.71 }, { "payer_name": "UHC - Adhoc", "plan_name": "UHC - Adhoc All Payer", "methodology": "case rate", "standard_charge_dollar": 24057.14 }, { "payer_name": "UHC - Adhoc", "plan_name": "UHC - Adhoc Oxford", "methodology": "case rate", "standard_charge_dollar": 20353.04 }, { "payer_name": "Wellcare", "plan_name": "Wellcare Insurance Exchange", "methodology": "case rate", "standard_charge_dollar": 23077.43, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "case rate", "standard_charge_dollar": 14033.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup Medicare", "methodology": "case rate", "standard_charge_dollar": 14033.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "case rate", "standard_charge_dollar": 30940.85, "additional_payer_notes": "181.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medical Rental Network", "methodology": "case rate", "standard_charge_dollar": 30940.85, "additional_payer_notes": "181.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "case rate", "standard_charge_dollar": 14033.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "ALLY-ALIGN (FKA SPARTAN PLAN NJ, INC.)", "plan_name": "ALLY-ALIGN (FKA SPARTAN PLAN NJ, INC.)", "methodology": "case rate", "standard_charge_dollar": 17949.11, "additional_payer_notes": "105.00% of Medicare Rates" } ] } ] }, { "description": "Hc Medication Admin & Hemodynamic Measurment", "code_information": [ { "code": "93463", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 1650.32, "minimum": 315.0461, "maximum": 1650.32, "payers_information": [ { "payer_name": "UHC", "plan_name": "UHC All Payer (02-01-2023 to 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 1650.32 }, { "payer_name": "UHC", "plan_name": "UHC Oxford (02-01-2023 to 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 1650.32 }, { "payer_name": "UHC - Adhoc", "plan_name": "UHC - Adhoc All Payer", "methodology": "case rate", "standard_charge_dollar": 1650.32 }, { "payer_name": "UHC - Adhoc", "plan_name": "UHC - Adhoc Oxford", "methodology": "case rate", "standard_charge_dollar": 1650.32 }, { "payer_name": "Wellchoice", "plan_name": "WELLCHOICE HMO of NJ (Empire) Commercial (HMO / HMO POS, PPO)", "methodology": "case rate", "standard_charge_dollar": 1650.32 }, { "payer_name": "Wellchoice", "plan_name": "WELLCHOICE HMO of NJ (Empire) Commercial (Indemnity)", "methodology": "case rate", "standard_charge_dollar": 1650.32 } ] } ] }, { "description": "Hc Urinalysis, Volume Measure", "code_information": [ { "code": "81050", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 16.0, "discounted_cash": 3.0, "minimum": 2.18, "maximum": 13.6, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 7.72, "additional_payer_notes": "212.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medical Rental Network", "methodology": "fee schedule", "standard_charge_dollar": 7.72, "additional_payer_notes": "212.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3.64, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "ALLY-ALIGN (FKA SPARTAN PLAN NJ, INC.)", "plan_name": "ALLY-ALIGN (FKA SPARTAN PLAN NJ, INC.)", "methodology": "fee schedule", "standard_charge_dollar": 3.82, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Americhoice (UHC)", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3.64, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Amerihealth", "plan_name": "Amerihealth Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3.64, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 5.28, "additional_payer_notes": "Laboratory - 145.00% of Medicare Rates" }, { "payer_name": "Clover Health", "plan_name": "Clover Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3.64, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Coventry", "plan_name": "Coventry Auto", "methodology": "fee schedule", "standard_charge_dollar": 7.28, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Coventry", "plan_name": "Coventry Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 7.28, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "fee schedule", "standard_charge_dollar": 5.1, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Fairprice Healthcare Holdings", "plan_name": "Fairprice Healthcare Holdings", "methodology": "fee schedule", "standard_charge_dollar": 4.37, "additional_payer_notes": "Laboratory - 120.00% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ HMO POS", "methodology": "fee schedule", "standard_charge_dollar": 11.3, "additional_payer_notes": "177.30% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ Indemnity", "methodology": "fee schedule", "standard_charge_dollar": 11.3, "additional_payer_notes": "177.30% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ PPO", "methodology": "fee schedule", "standard_charge_dollar": 11.3, "additional_payer_notes": "177.30% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3.64, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Military Tricare", "methodology": "fee schedule", "standard_charge_dollar": 2.91, "additional_payer_notes": "80.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3.64, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 3.64, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC All Payer (02-01-2023 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 2.18 }, { "payer_name": "UHC", "plan_name": "UHC Medicaid (02/01/2023 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 2.91 }, { "payer_name": "UHC", "plan_name": "UHC Oxford (02-01-2023 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 2.18 }, { "payer_name": "UHC - Adhoc", "plan_name": "UHC - Adhoc All Payer", "methodology": "fee schedule", "standard_charge_dollar": 3.64 }, { "payer_name": "UHC - Adhoc", "plan_name": "UHC - Adhoc Oxford", "methodology": "fee schedule", "standard_charge_dollar": 3.64 }, { "payer_name": "Wellcare", "plan_name": "Wellcare Insurance Exchange", "methodology": "fee schedule", "standard_charge_dollar": 4.91, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3.64, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3.64, "additional_payer_notes": "100.00% of Medicare Rates" } ] } ] }, { "description": "Hc Assay Of Vip", "code_information": [ { "code": "84586", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 131.0, "discounted_cash": 35.0, "minimum": 21.2, "maximum": 111.35, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 74.9, "additional_payer_notes": "212.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medical Rental Network", "methodology": "fee schedule", "standard_charge_dollar": 74.9, "additional_payer_notes": "212.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 35.33, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "ALLY-ALIGN (FKA SPARTAN PLAN NJ, INC.)", "plan_name": "ALLY-ALIGN (FKA SPARTAN PLAN NJ, INC.)", "methodology": "fee schedule", "standard_charge_dollar": 37.1, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Americhoice (UHC)", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 35.33, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Amerihealth", "plan_name": "Amerihealth Medicare", "methodology": "fee schedule", "standard_charge_dollar": 35.33, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 51.23, "additional_payer_notes": "Laboratory - 145.00% of Medicare Rates" }, { "payer_name": "Clover Health", "plan_name": "Clover Medicare", "methodology": "fee schedule", "standard_charge_dollar": 35.33, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Coventry", "plan_name": "Coventry Auto", "methodology": "fee schedule", "standard_charge_dollar": 70.66, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Coventry", "plan_name": "Coventry Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 70.66, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "fee schedule", "standard_charge_dollar": 49.46, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Fairprice Healthcare Holdings", "plan_name": "Fairprice Healthcare Holdings", "methodology": "fee schedule", "standard_charge_dollar": 42.4, "additional_payer_notes": "Laboratory - 120.00% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ HMO POS", "methodology": "fee schedule", "standard_charge_dollar": 92.49, "additional_payer_notes": "177.30% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ Indemnity", "methodology": "fee schedule", "standard_charge_dollar": 92.49, "additional_payer_notes": "177.30% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ PPO", "methodology": "fee schedule", "standard_charge_dollar": 92.49, "additional_payer_notes": "177.30% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon Medicare", "methodology": "fee schedule", "standard_charge_dollar": 35.33, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Military Tricare", "methodology": "fee schedule", "standard_charge_dollar": 28.26, "additional_payer_notes": "80.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 35.33, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 35.33, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC All Payer (02-01-2023 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 21.2 }, { "payer_name": "UHC", "plan_name": "UHC Medicaid (02/01/2023 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 28.26 }, { "payer_name": "UHC", "plan_name": "UHC Oxford (02-01-2023 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 21.2 }, { "payer_name": "UHC - Adhoc", "plan_name": "UHC - Adhoc All Payer", "methodology": "fee schedule", "standard_charge_dollar": 35.33 }, { "payer_name": "UHC - Adhoc", "plan_name": "UHC - Adhoc Oxford", "methodology": "fee schedule", "standard_charge_dollar": 35.33 }, { "payer_name": "Wellcare", "plan_name": "Wellcare Insurance Exchange", "methodology": "fee schedule", "standard_charge_dollar": 47.7, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 35.33, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup Medicare", "methodology": "fee schedule", "standard_charge_dollar": 35.33, "additional_payer_notes": "100.00% of Medicare Rates" } ] } ] }, { "description": "Hc Endovasc Viscer Aorta Repair Fenest 2 Endograft", "code_information": [ { "code": "34842", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 7000.0, "minimum": 1061.13, "maximum": 5600.0, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1061.13, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC All Payer (02-01-2023 to 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 4889.0 }, { "payer_name": "UHC", "plan_name": "UHC Oxford (02-01-2023 to 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 4020.0 }, { "payer_name": "UHC - Adhoc", "plan_name": "UHC - Adhoc All Payer", "methodology": "case rate", "standard_charge_dollar": 5190.0 }, { "payer_name": "UHC - Adhoc", "plan_name": "UHC - Adhoc Oxford", "methodology": "case rate", "standard_charge_dollar": 4143.0 }, { "payer_name": "Wellchoice", "plan_name": "WELLCHOICE HMO of NJ (Empire) Commercial (HMO / HMO POS, PPO)", "methodology": "case rate", "standard_charge_dollar": 1715.0 }, { "payer_name": "Wellchoice", "plan_name": "WELLCHOICE HMO of NJ (Empire) Commercial (Indemnity)", "methodology": "case rate", "standard_charge_dollar": 1978.0 } ] } ] }, { "description": "Hc Thoracoscopy Diag Mediast W Biopsy", "code_information": [ { "code": "32606", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 1000.0, "discounted_cash": 7147.0, "minimum": 190.9, "maximum": 1000.0, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 1000.0, "additional_payer_notes": "212.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medical Rental Network", "methodology": "fee schedule", "standard_charge_dollar": 1000.0, "additional_payer_notes": "212.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1000.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "ALLY-ALIGN (FKA SPARTAN PLAN NJ, INC.)", "plan_name": "ALLY-ALIGN (FKA SPARTAN PLAN NJ, INC.)", "methodology": "fee schedule", "standard_charge_dollar": 1000.0, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Americhoice (UHC)", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1000.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Amerihealth", "plan_name": "Amerihealth Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1000.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 1000.0, "additional_payer_notes": "146.95% of Medicare Rates" }, { "payer_name": "Clover Health", "plan_name": "Clover Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1000.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Coventry", "plan_name": "Coventry Auto", "methodology": "fee schedule", "standard_charge_dollar": 1000.0, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Coventry", "plan_name": "Coventry Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 1000.0, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "fee schedule", "standard_charge_dollar": 1000.0, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Fairprice Healthcare Holdings", "plan_name": "Fairprice Healthcare Holdings", "methodology": "fee schedule", "standard_charge_dollar": 1000.0, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ HMO POS", "methodology": "fee schedule", "standard_charge_dollar": 1000.0, "additional_payer_notes": "177.30% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ Indemnity", "methodology": "fee schedule", "standard_charge_dollar": 1000.0, "additional_payer_notes": "177.30% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ PPO", "methodology": "fee schedule", "standard_charge_dollar": 1000.0, "additional_payer_notes": "177.30% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1000.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Military Tricare", "methodology": "fee schedule", "standard_charge_dollar": 1000.0, "additional_payer_notes": "80.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1000.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 1000.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC All Payer (02-01-2023 to 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 1000.0 }, { "payer_name": "UHC", "plan_name": "UHC Oxford (02-01-2023 to 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 1000.0 }, { "payer_name": "UHC - Adhoc", "plan_name": "UHC - Adhoc All Payer", "methodology": "case rate", "standard_charge_dollar": 1000.0 }, { "payer_name": "UHC - Adhoc", "plan_name": "UHC - Adhoc Oxford", "methodology": "case rate", "standard_charge_dollar": 1000.0 }, { "payer_name": "Wellcare", "plan_name": "Wellcare Insurance Exchange", "methodology": "fee schedule", "standard_charge_dollar": 1000.0, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1000.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellchoice", "plan_name": "WELLCHOICE HMO of NJ (Empire) Commercial (HMO / HMO POS, PPO)", "methodology": "case rate", "standard_charge_dollar": 1000.0 }, { "payer_name": "Wellchoice", "plan_name": "WELLCHOICE HMO of NJ (Empire) Commercial (Indemnity)", "methodology": "case rate", "standard_charge_dollar": 1000.0 }, { "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1000.0, "additional_payer_notes": "100.00% of Medicare Rates" } ] } ] }, { "description": "Hc Repair Exten Tendon,Dorsum Hand,Ea", "code_information": [ { "code": "26410", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 4895.38, "discounted_cash": 1900.0, "minimum": 934.528, "maximum": 4153.0, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 4030.06, "additional_payer_notes": "212.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medical Rental Network", "methodology": "fee schedule", "standard_charge_dollar": 4030.06, "additional_payer_notes": "212.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1900.97, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "ALLY-ALIGN (FKA SPARTAN PLAN NJ, INC.)", "plan_name": "ALLY-ALIGN (FKA SPARTAN PLAN NJ, INC.)", "methodology": "fee schedule", "standard_charge_dollar": 1996.02, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Americhoice (UHC)", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1900.97, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Amerihealth", "plan_name": "Amerihealth Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1900.97, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 2793.48, "additional_payer_notes": "146.95% of Medicare Rates" }, { "payer_name": "Clover Health", "plan_name": "Clover Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1900.97, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Coventry", "plan_name": "Coventry Auto", "methodology": "fee schedule", "standard_charge_dollar": 3801.94, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Coventry", "plan_name": "Coventry Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 3801.94, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "fee schedule", "standard_charge_dollar": 2661.36, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Fairprice Healthcare Holdings", "plan_name": "Fairprice Healthcare Holdings", "methodology": "fee schedule", "standard_charge_dollar": 3041.55, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ HMO POS", "methodology": "fee schedule", "standard_charge_dollar": 3370.42, "additional_payer_notes": "177.30% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ Indemnity", "methodology": "fee schedule", "standard_charge_dollar": 3370.42, "additional_payer_notes": "177.30% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ PPO", "methodology": "fee schedule", "standard_charge_dollar": 3370.42, "additional_payer_notes": "177.30% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1900.97, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Military Tricare", "methodology": "fee schedule", "standard_charge_dollar": 1520.78, "additional_payer_notes": "80.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1900.97, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 1900.97, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC All Payer (02-01-2023 to 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 3912.0 }, { "payer_name": "UHC", "plan_name": "UHC Oxford (02-01-2023 to 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 3676.0 }, { "payer_name": "UHC - Adhoc", "plan_name": "UHC - Adhoc All Payer", "methodology": "case rate", "standard_charge_dollar": 4153.0 }, { "payer_name": "UHC - Adhoc", "plan_name": "UHC - Adhoc Oxford", "methodology": "case rate", "standard_charge_dollar": 3788.0 }, { "payer_name": "Wellcare", "plan_name": "Wellcare Insurance Exchange", "methodology": "fee schedule", "standard_charge_dollar": 2566.31, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1900.97, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellchoice", "plan_name": "WELLCHOICE HMO of NJ (Empire) Commercial (HMO / HMO POS, PPO)", "methodology": "case rate", "standard_charge_dollar": 1715.0 }, { "payer_name": "Wellchoice", "plan_name": "WELLCHOICE HMO of NJ (Empire) Commercial (Indemnity)", "methodology": "case rate", "standard_charge_dollar": 1978.0 }, { "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1900.97, "additional_payer_notes": "100.00% of Medicare Rates" } ] } ] }, { "description": "OTHER MAJOR CARDIOVASCULAR PROCEDURES WITH MCC", "code_information": [ { "code": "270", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 62532.0, "minimum": 4786.72, "maximum": 113183.1372, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "case rate", "standard_charge_dollar": 113183.14, "additional_payer_notes": "181.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medical Rental Network", "methodology": "case rate", "standard_charge_dollar": 113183.14, "additional_payer_notes": "181.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "case rate", "standard_charge_dollar": 50518.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "ALLY-ALIGN (FKA SPARTAN PLAN NJ, INC.)", "plan_name": "ALLY-ALIGN (FKA SPARTAN PLAN NJ, INC.)", "methodology": "case rate", "standard_charge_dollar": 65658.73, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Americhoice (UHC)", "plan_name": "UHC Medicare", "methodology": "case rate", "standard_charge_dollar": 50518.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Amerihealth", "plan_name": "Amerihealth Medicare", "methodology": "case rate", "standard_charge_dollar": 50518.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Commercial", "methodology": "case rate", "standard_charge_dollar": 77192.27 }, { "payer_name": "Clover Health", "plan_name": "Clover Medicare", "methodology": "case rate", "standard_charge_dollar": 50518.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Coventry", "plan_name": "Coventry Auto", "methodology": "case rate", "standard_charge_dollar": 106304.6, "additional_payer_notes": "170.00% of Medicare Rates" }, { "payer_name": "Coventry", "plan_name": "Coventry Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 106304.6, "additional_payer_notes": "170.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "case rate", "standard_charge_dollar": 81291.76, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Fairprice Healthcare Holdings", "plan_name": "Fairprice Healthcare Holdings", "methodology": "case rate", "standard_charge_dollar": 100051.39, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon Medicare", "methodology": "case rate", "standard_charge_dollar": 50518.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon NJ Health Medicaid", "methodology": "case rate", "standard_charge_dollar": 31606.95 }, { "payer_name": "Humana", "plan_name": "Humana Military Tricare", "methodology": "case rate", "standard_charge_dollar": 50025.7, "additional_payer_notes": "80.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 62532.12, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 4786.72 }, { "payer_name": "UBH", "plan_name": "UBH Medicare", "methodology": "case rate", "standard_charge_dollar": 50518.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC All Payer (02-01-2023 to 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 88937.31 }, { "payer_name": "UHC", "plan_name": "UHC Oxford (02-01-2023 to 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 77508.85 }, { "payer_name": "UHC - Adhoc", "plan_name": "UHC - Adhoc All Payer", "methodology": "case rate", "standard_charge_dollar": 94408.84 }, { "payer_name": "UHC - Adhoc", "plan_name": "UHC - Adhoc Oxford", "methodology": "case rate", "standard_charge_dollar": 79872.63 }, { "payer_name": "Wellcare", "plan_name": "Wellcare Insurance Exchange", "methodology": "case rate", "standard_charge_dollar": 84418.36, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "case rate", "standard_charge_dollar": 50518.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup Medicare", "methodology": "case rate", "standard_charge_dollar": 50518.3, "additional_payer_notes": "100.00% of Medicare Rates" } ] } ] }, { "description": "INSERT INTRAUTERINE DEVICE", "code_information": [ { "code": "58300", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 10260.0, "minimum": 1715.0, "maximum": 8208.0, "payers_information": [ { "payer_name": "UHC", "plan_name": "UHC All Payer (02-01-2023 to 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 3057.0 }, { "payer_name": "UHC", "plan_name": "UHC Oxford (02-01-2023 to 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 2297.0 }, { "payer_name": "UHC - Adhoc", "plan_name": "UHC - Adhoc All Payer", "methodology": "case rate", "standard_charge_dollar": 3245.0 }, { "payer_name": "UHC - Adhoc", "plan_name": "UHC - Adhoc Oxford", "methodology": "case rate", "standard_charge_dollar": 2367.0 }, { "payer_name": "Wellchoice", "plan_name": "WELLCHOICE HMO of NJ (Empire) Commercial (HMO / HMO POS, PPO)", "methodology": "case rate", "standard_charge_dollar": 1715.0 }, { "payer_name": "Wellchoice", "plan_name": "WELLCHOICE HMO of NJ (Empire) Commercial (Indemnity)", "methodology": "case rate", "standard_charge_dollar": 1978.0 } ] } ] }, { "description": "PERIPHERAL, CRANIAL & AUTONOMIC NERVE DISORDERS - SOI : 3", "code_information": [ { "code": "0483", "type": "APR-DRG" } ], "standard_charges": [ { "setting": "inpatient", "minimum": 12079.48, "maximum": 13287.42, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Better Health - Medi Medi", "methodology": "case rate", "standard_charge_dollar": 13287.42, "additional_payer_notes": "110% of State Medicaid Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Better Health Medicaid", "methodology": "case rate", "standard_charge_dollar": 13287.42, "additional_payer_notes": "110% of State Medicaid Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "case rate", "standard_charge_dollar": 12079.48, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "UBH", "plan_name": "UBH Medicaid", "methodology": "case rate", "standard_charge_dollar": 12079.48, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicaid (02/01/2023 to 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 12321.07, "additional_payer_notes": "102% of State Medicaid Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicaid", "methodology": "case rate", "standard_charge_dollar": 12079.48, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup Medicaid", "methodology": "case rate", "standard_charge_dollar": 12079.48, "additional_payer_notes": "100% of State Medicaid Rates" } ] } ] }, { "description": "MALFUNCTION, REACTION, COMPLIC OF GENITOURINARY DEVICE OR PROC - SOI : 4", "code_information": [ { "code": "4664", "type": "APR-DRG" } ], "standard_charges": [ { "setting": "inpatient", "minimum": 17773.14, "maximum": 19550.45, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Better Health - Medi Medi", "methodology": "case rate", "standard_charge_dollar": 19550.45, "additional_payer_notes": "110% of State Medicaid Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Better Health Medicaid", "methodology": "case rate", "standard_charge_dollar": 19550.45, "additional_payer_notes": "110% of State Medicaid Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "case rate", "standard_charge_dollar": 17773.14, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "UBH", "plan_name": "UBH Medicaid", "methodology": "case rate", "standard_charge_dollar": 17773.14, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicaid (02/01/2023 to 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 18128.6, "additional_payer_notes": "102% of State Medicaid Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicaid", "methodology": "case rate", "standard_charge_dollar": 17773.14, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup Medicaid", "methodology": "case rate", "standard_charge_dollar": 17773.14, "additional_payer_notes": "100% of State Medicaid Rates" } ] } ] }, { "description": "PERITONEAL ADHESIOLYSIS - SOI : 2", "code_information": [ { "code": "2242", "type": "APR-DRG" } ], "standard_charges": [ { "setting": "inpatient", "minimum": 20165.58, "maximum": 22182.14, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Better Health - Medi Medi", "methodology": "case rate", "standard_charge_dollar": 22182.14, "additional_payer_notes": "110% of State Medicaid Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Better Health Medicaid", "methodology": "case rate", "standard_charge_dollar": 22182.14, "additional_payer_notes": "110% of State Medicaid Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "case rate", "standard_charge_dollar": 20165.58, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "UBH", "plan_name": "UBH Medicaid", "methodology": "case rate", "standard_charge_dollar": 20165.58, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicaid (02/01/2023 to 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 20568.89, "additional_payer_notes": "102% of State Medicaid Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicaid", "methodology": "case rate", "standard_charge_dollar": 20165.58, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup Medicaid", "methodology": "case rate", "standard_charge_dollar": 20165.58, "additional_payer_notes": "100% of State Medicaid Rates" } ] } ] }, { "description": "Hc Mra Abdomen W Contrast - C8900 - 61800001", "code_information": [ { "code": "C8900", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 4739.46, "discounted_cash": 412.0, "minimum": 329.952, "maximum": 4028.541, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 874.37, "additional_payer_notes": "212.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medical Rental Network", "methodology": "fee schedule", "standard_charge_dollar": 874.37, "additional_payer_notes": "212.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 412.44, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "ALLY-ALIGN (FKA SPARTAN PLAN NJ, INC.)", "plan_name": "ALLY-ALIGN (FKA SPARTAN PLAN NJ, INC.)", "methodology": "fee schedule", "standard_charge_dollar": 433.06, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Americhoice (UHC)", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 412.44, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Amerihealth", "plan_name": "Amerihealth HMO", "methodology": "fee schedule", "standard_charge_dollar": 886.6 }, { "payer_name": "Amerihealth", "plan_name": "Amerihealth Medicare", "methodology": "fee schedule", "standard_charge_dollar": 412.44, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 606.08, "additional_payer_notes": "146.95% of Medicare Rates" }, { "payer_name": "Clover Health", "plan_name": "Clover Medicare", "methodology": "fee schedule", "standard_charge_dollar": 412.44, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Coventry", "plan_name": "Coventry Auto", "methodology": "fee schedule", "standard_charge_dollar": 824.88, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Coventry", "plan_name": "Coventry Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 824.88, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "fee schedule", "standard_charge_dollar": 577.42, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Fairprice Healthcare Holdings", "plan_name": "Fairprice Healthcare Holdings", "methodology": "fee schedule", "standard_charge_dollar": 659.9, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ HMO POS", "methodology": "fee schedule", "standard_charge_dollar": 731.26, "additional_payer_notes": "177.30% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ Indemnity", "methodology": "fee schedule", "standard_charge_dollar": 731.26, "additional_payer_notes": "177.30% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ PPO", "methodology": "fee schedule", "standard_charge_dollar": 731.26, "additional_payer_notes": "177.30% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon Medicare", "methodology": "fee schedule", "standard_charge_dollar": 412.44, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Military Tricare", "methodology": "fee schedule", "standard_charge_dollar": 329.95, "additional_payer_notes": "80.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 412.44, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 412.44, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC All Payer (02-01-2023 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 552.18 }, { "payer_name": "UHC", "plan_name": "UHC Oxford (02-01-2023 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 552.18 }, { "payer_name": "UHC - Adhoc", "plan_name": "UHC - Adhoc All Payer", "methodology": "fee schedule", "standard_charge_dollar": 368.12 }, { "payer_name": "UHC - Adhoc", "plan_name": "UHC - Adhoc Oxford", "methodology": "fee schedule", "standard_charge_dollar": 368.12 }, { "payer_name": "Wellcare", "plan_name": "Wellcare Insurance Exchange", "methodology": "fee schedule", "standard_charge_dollar": 556.79, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 412.44, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup Medicare", "methodology": "fee schedule", "standard_charge_dollar": 412.44, "additional_payer_notes": "100.00% of Medicare Rates" } ] } ] }, { "description": "CHOLECYSTECTOMY EXCEPT BY LAPAROSCOPE WITHOUT C.D.E. WITHOUT CCMCC", "code_information": [ { "code": "416", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 17311.0, "minimum": 8698.98, "maximum": 31334.1046, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "case rate", "standard_charge_dollar": 31334.1, "additional_payer_notes": "181.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medical Rental Network", "methodology": "case rate", "standard_charge_dollar": 31334.1, "additional_payer_notes": "181.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "case rate", "standard_charge_dollar": 14207.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "ALLY-ALIGN (FKA SPARTAN PLAN NJ, INC.)", "plan_name": "ALLY-ALIGN (FKA SPARTAN PLAN NJ, INC.)", "methodology": "case rate", "standard_charge_dollar": 18177.24, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Americhoice (UHC)", "plan_name": "UHC Medicare", "methodology": "case rate", "standard_charge_dollar": 14207.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Amerihealth", "plan_name": "Amerihealth Medicare", "methodology": "case rate", "standard_charge_dollar": 14207.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Commercial", "methodology": "case rate", "standard_charge_dollar": 19945.08 }, { "payer_name": "Clover Health", "plan_name": "Clover Medicare", "methodology": "case rate", "standard_charge_dollar": 14207.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Coventry", "plan_name": "Coventry Auto", "methodology": "case rate", "standard_charge_dollar": 29429.82, "additional_payer_notes": "170.00% of Medicare Rates" }, { "payer_name": "Coventry", "plan_name": "Coventry Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 29429.82, "additional_payer_notes": "170.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "case rate", "standard_charge_dollar": 22505.16, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Fairprice Healthcare Holdings", "plan_name": "Fairprice Healthcare Holdings", "methodology": "case rate", "standard_charge_dollar": 27698.66, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon Medicare", "methodology": "case rate", "standard_charge_dollar": 14207.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon NJ Health Medicaid", "methodology": "case rate", "standard_charge_dollar": 8698.98 }, { "payer_name": "Humana", "plan_name": "Humana Military Tricare", "methodology": "case rate", "standard_charge_dollar": 13849.33, "additional_payer_notes": "80.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 17311.66, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 29779.3 }, { "payer_name": "UBH", "plan_name": "UBH Medicare", "methodology": "case rate", "standard_charge_dollar": 14207.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC All Payer (02-01-2023 to 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 22979.78 }, { "payer_name": "UHC", "plan_name": "UHC Oxford (02-01-2023 to 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 20026.88 }, { "payer_name": "UHC - Adhoc", "plan_name": "UHC - Adhoc All Payer", "methodology": "case rate", "standard_charge_dollar": 24393.53 }, { "payer_name": "UHC - Adhoc", "plan_name": "UHC - Adhoc Oxford", "methodology": "case rate", "standard_charge_dollar": 20637.64 }, { "payer_name": "Wellcare", "plan_name": "Wellcare Insurance Exchange", "methodology": "case rate", "standard_charge_dollar": 23370.74, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "case rate", "standard_charge_dollar": 14207.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup Medicare", "methodology": "case rate", "standard_charge_dollar": 14207.5, "additional_payer_notes": "100.00% of Medicare Rates" } ] } ] }, { "description": "HEART &OR LUNG TRANSPLANT - SOI : 4", "code_information": [ { "code": "0024", "type": "APR-DRG" } ], "standard_charges": [ { "setting": "inpatient", "minimum": 298215.79, "maximum": 328037.37, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Better Health - Medi Medi", "methodology": "case rate", "standard_charge_dollar": 328037.37, "additional_payer_notes": "110% of State Medicaid Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Better Health Medicaid", "methodology": "case rate", "standard_charge_dollar": 328037.37, "additional_payer_notes": "110% of State Medicaid Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "case rate", "standard_charge_dollar": 298215.79, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "UBH", "plan_name": "UBH Medicaid", "methodology": "case rate", "standard_charge_dollar": 298215.79, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicaid (02/01/2023 to 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 304180.11, "additional_payer_notes": "102% of State Medicaid Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicaid", "methodology": "case rate", "standard_charge_dollar": 298215.79, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup Medicaid", "methodology": "case rate", "standard_charge_dollar": 298215.79, "additional_payer_notes": "100% of State Medicaid Rates" } ] } ] }, { "description": "Hc (Sup Shell C1729) Catheter Drainage", "code_information": [ { "code": "C1729", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "payers_information": [ { "payer_name": "Horizon", "plan_name": "Horizon NJ Health Medicaid", "methodology": "percent of total billed charges", "standard_charge_percentage": 19.58, "median_amount": 36.93, "10th_percentile": 36.93, "90th_percentile": 57.07, "count": "1 through 10" }, { "payer_name": "UHC", "plan_name": "UHC Medicaid (02/01/2023 to 12-31-2026)", "methodology": "percent of total billed charges", "standard_charge_percentage": 19.47, "median_amount": 35.88, "10th_percentile": 35.88, "90th_percentile": 35.88, "count": "1 through 10" }, { "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup Medicaid", "methodology": "percent of total billed charges", "standard_charge_percentage": 19.09, "median_amount": 35.18, "10th_percentile": 35.18, "90th_percentile": 35.18, "count": "1 through 10" } ] } ] }, { "description": "BIOPSIES OF MUSCULOSKELETAL SYSTEM AND CONNECTIVE TISSUE WITHOUT CCMCC", "code_information": [ { "code": "479", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 23039.0, "minimum": 11227.31, "maximum": 41700.6624, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "case rate", "standard_charge_dollar": 41700.66, "additional_payer_notes": "181.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medical Rental Network", "methodology": "case rate", "standard_charge_dollar": 41700.66, "additional_payer_notes": "181.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "case rate", "standard_charge_dollar": 18806.4, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "ALLY-ALIGN (FKA SPARTAN PLAN NJ, INC.)", "plan_name": "ALLY-ALIGN (FKA SPARTAN PLAN NJ, INC.)", "methodology": "case rate", "standard_charge_dollar": 24190.99, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Americhoice (UHC)", "plan_name": "UHC Medicare", "methodology": "case rate", "standard_charge_dollar": 18806.4, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Amerihealth", "plan_name": "Amerihealth Medicare", "methodology": "case rate", "standard_charge_dollar": 18806.4, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Commercial", "methodology": "case rate", "standard_charge_dollar": 27195.71 }, { "payer_name": "Clover Health", "plan_name": "Clover Medicare", "methodology": "case rate", "standard_charge_dollar": 18806.4, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Coventry", "plan_name": "Coventry Auto", "methodology": "case rate", "standard_charge_dollar": 39166.37, "additional_payer_notes": "170.00% of Medicare Rates" }, { "payer_name": "Coventry", "plan_name": "Coventry Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 39166.37, "additional_payer_notes": "170.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "case rate", "standard_charge_dollar": 29950.75, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Fairprice Healthcare Holdings", "plan_name": "Fairprice Healthcare Holdings", "methodology": "case rate", "standard_charge_dollar": 36862.46, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon Medicare", "methodology": "case rate", "standard_charge_dollar": 18806.4, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon NJ Health Medicaid", "methodology": "case rate", "standard_charge_dollar": 11227.31 }, { "payer_name": "Humana", "plan_name": "Humana Military Tricare", "methodology": "case rate", "standard_charge_dollar": 18431.23, "additional_payer_notes": "80.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 23039.04, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 21951.8 }, { "payer_name": "UBH", "plan_name": "UBH Medicare", "methodology": "case rate", "standard_charge_dollar": 18806.4, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC All Payer (02-01-2023 to 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 31333.62 }, { "payer_name": "UHC", "plan_name": "UHC Oxford (02-01-2023 to 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 27307.24 }, { "payer_name": "UHC - Adhoc", "plan_name": "UHC - Adhoc All Payer", "methodology": "case rate", "standard_charge_dollar": 33261.3 }, { "payer_name": "UHC - Adhoc", "plan_name": "UHC - Adhoc Oxford", "methodology": "case rate", "standard_charge_dollar": 28140.03 }, { "payer_name": "Wellcare", "plan_name": "Wellcare Insurance Exchange", "methodology": "case rate", "standard_charge_dollar": 31102.7, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "case rate", "standard_charge_dollar": 18806.4, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup Medicare", "methodology": "case rate", "standard_charge_dollar": 18806.4, "additional_payer_notes": "100.00% of Medicare Rates" } ] } ] }, { "description": "Hc Acoustic Immitance Testing", "code_information": [ { "code": "92570", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 255.0, "discounted_cash": 152.0, "minimum": 48.6795, "maximum": 255.0, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 255.0, "additional_payer_notes": "212.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medical Rental Network", "methodology": "fee schedule", "standard_charge_dollar": 255.0, "additional_payer_notes": "212.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 152.11, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "ALLY-ALIGN (FKA SPARTAN PLAN NJ, INC.)", "plan_name": "ALLY-ALIGN (FKA SPARTAN PLAN NJ, INC.)", "methodology": "fee schedule", "standard_charge_dollar": 159.72, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Americhoice (UHC)", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 152.11, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Amerihealth", "plan_name": "Amerihealth Medicare", "methodology": "fee schedule", "standard_charge_dollar": 152.11, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 223.53, "additional_payer_notes": "146.95% of Medicare Rates" }, { "payer_name": "Clover Health", "plan_name": "Clover Medicare", "methodology": "fee schedule", "standard_charge_dollar": 152.11, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Coventry", "plan_name": "Coventry Auto", "methodology": "fee schedule", "standard_charge_dollar": 255.0, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Coventry", "plan_name": "Coventry Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 255.0, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "fee schedule", "standard_charge_dollar": 212.95, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Fairprice Healthcare Holdings", "plan_name": "Fairprice Healthcare Holdings", "methodology": "fee schedule", "standard_charge_dollar": 243.38, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ HMO POS", "methodology": "fee schedule", "standard_charge_dollar": 255.0, "additional_payer_notes": "177.30% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ Indemnity", "methodology": "fee schedule", "standard_charge_dollar": 255.0, "additional_payer_notes": "177.30% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ PPO", "methodology": "fee schedule", "standard_charge_dollar": 255.0, "additional_payer_notes": "177.30% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon Medicare", "methodology": "fee schedule", "standard_charge_dollar": 152.11, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Military Tricare", "methodology": "fee schedule", "standard_charge_dollar": 121.69, "additional_payer_notes": "80.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 152.11, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 152.11, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC All Payer (02-01-2023 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 255.0 }, { "payer_name": "UHC", "plan_name": "UHC Oxford (02-01-2023 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 255.0 }, { "payer_name": "UHC - Adhoc", "plan_name": "UHC - Adhoc All Payer", "methodology": "fee schedule", "standard_charge_dollar": 255.0 }, { "payer_name": "UHC - Adhoc", "plan_name": "UHC - Adhoc Oxford", "methodology": "fee schedule", "standard_charge_dollar": 255.0 }, { "payer_name": "Wellcare", "plan_name": "Wellcare Insurance Exchange", "methodology": "fee schedule", "standard_charge_dollar": 205.35, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 152.11, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup Medicare", "methodology": "fee schedule", "standard_charge_dollar": 152.11, "additional_payer_notes": "100.00% of Medicare Rates" } ] } ] }, { "description": "DENTAL AND ORAL DISEASES WITH CC", "code_information": [ { "code": "158", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 12070.0, "minimum": 5559.33, "maximum": 21848.148, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "case rate", "standard_charge_dollar": 21848.15, "additional_payer_notes": "181.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medical Rental Network", "methodology": "case rate", "standard_charge_dollar": 21848.15, "additional_payer_notes": "181.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "case rate", "standard_charge_dollar": 9999.24, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "ALLY-ALIGN (FKA SPARTAN PLAN NJ, INC.)", "plan_name": "ALLY-ALIGN (FKA SPARTAN PLAN NJ, INC.)", "methodology": "case rate", "standard_charge_dollar": 12674.34, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Americhoice (UHC)", "plan_name": "UHC Medicare", "methodology": "case rate", "standard_charge_dollar": 9999.24, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Amerihealth", "plan_name": "Amerihealth Medicare", "methodology": "case rate", "standard_charge_dollar": 9999.24, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Commercial", "methodology": "case rate", "standard_charge_dollar": 13310.37 }, { "payer_name": "Clover Health", "plan_name": "Clover Medicare", "methodology": "case rate", "standard_charge_dollar": 9999.24, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Coventry", "plan_name": "Coventry Auto", "methodology": "case rate", "standard_charge_dollar": 20520.36, "additional_payer_notes": "170.00% of Medicare Rates" }, { "payer_name": "Coventry", "plan_name": "Coventry Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 20520.36, "additional_payer_notes": "170.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "case rate", "standard_charge_dollar": 15692.04, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Fairprice Healthcare Holdings", "plan_name": "Fairprice Healthcare Holdings", "methodology": "case rate", "standard_charge_dollar": 19313.28, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon Medicare", "methodology": "case rate", "standard_charge_dollar": 9999.24, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon NJ Health Medicaid", "methodology": "case rate", "standard_charge_dollar": 5559.33 }, { "payer_name": "Humana", "plan_name": "Humana Military Tricare", "methodology": "case rate", "standard_charge_dollar": 9656.64, "additional_payer_notes": "80.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 12070.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 10757.0 }, { "payer_name": "UBH", "plan_name": "UBH Medicare", "methodology": "case rate", "standard_charge_dollar": 9999.24, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC All Payer (02-01-2023 to 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 15335.59 }, { "payer_name": "UHC", "plan_name": "UHC Oxford (02-01-2023 to 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 13364.96 }, { "payer_name": "UHC - Adhoc", "plan_name": "UHC - Adhoc All Payer", "methodology": "case rate", "standard_charge_dollar": 16279.05 }, { "payer_name": "UHC - Adhoc", "plan_name": "UHC - Adhoc Oxford", "methodology": "case rate", "standard_charge_dollar": 13772.55 }, { "payer_name": "Wellcare", "plan_name": "Wellcare Insurance Exchange", "methodology": "case rate", "standard_charge_dollar": 16295.58, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "case rate", "standard_charge_dollar": 9999.24, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup Medicare", "methodology": "case rate", "standard_charge_dollar": 9999.24, "additional_payer_notes": "100.00% of Medicare Rates" } ] } ] }, { "description": "Hc Rem Interrog Pm/Ldls Pm <90 D Phys/Qhp", "code_information": [ { "code": "93294", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 1000.0, "minimum": 190.9, "maximum": 1000.0, "payers_information": [ { "payer_name": "UHC - Adhoc", "plan_name": "UHC - Adhoc Oxford", "methodology": "fee schedule", "standard_charge_dollar": 1000.0 }, { "payer_name": "UHC", "plan_name": "UHC All Payer (02-01-2023 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 1000.0 }, { "payer_name": "UHC", "plan_name": "UHC Oxford (02-01-2023 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 1000.0 }, { "payer_name": "UHC - Adhoc", "plan_name": "UHC - Adhoc All Payer", "methodology": "fee schedule", "standard_charge_dollar": 1000.0 } ] } ] }, { "description": "Hc Arc Rbc Pretreatment/Chem Or Drugs", "code_information": [ { "code": "86970", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 171.0, "discounted_cash": 69.0, "minimum": 15.0, "maximum": 147.8488, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 147.85, "additional_payer_notes": "212.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medical Rental Network", "methodology": "fee schedule", "standard_charge_dollar": 147.85, "additional_payer_notes": "212.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 69.74, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "ALLY-ALIGN (FKA SPARTAN PLAN NJ, INC.)", "plan_name": "ALLY-ALIGN (FKA SPARTAN PLAN NJ, INC.)", "methodology": "fee schedule", "standard_charge_dollar": 73.23, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Americhoice (UHC)", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 69.74, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Amerihealth", "plan_name": "Amerihealth Medicare", "methodology": "fee schedule", "standard_charge_dollar": 69.74, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 102.48, "additional_payer_notes": "146.95% of Medicare Rates" }, { "payer_name": "Clover Health", "plan_name": "Clover Medicare", "methodology": "fee schedule", "standard_charge_dollar": 69.74, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Coventry", "plan_name": "Coventry Auto", "methodology": "fee schedule", "standard_charge_dollar": 139.48, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Coventry", "plan_name": "Coventry Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 139.48, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "fee schedule", "standard_charge_dollar": 97.64, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Fairprice Healthcare Holdings", "plan_name": "Fairprice Healthcare Holdings", "methodology": "fee schedule", "standard_charge_dollar": 111.58, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ HMO POS", "methodology": "fee schedule", "standard_charge_dollar": 123.65, "additional_payer_notes": "177.30% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ Indemnity", "methodology": "fee schedule", "standard_charge_dollar": 123.65, "additional_payer_notes": "177.30% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ PPO", "methodology": "fee schedule", "standard_charge_dollar": 123.65, "additional_payer_notes": "177.30% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon Medicare", "methodology": "fee schedule", "standard_charge_dollar": 69.74, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Military Tricare", "methodology": "fee schedule", "standard_charge_dollar": 55.79, "additional_payer_notes": "80.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 69.74, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 69.74, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC All Payer (02-01-2023 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 20.06 }, { "payer_name": "UHC", "plan_name": "UHC Medicaid (02/01/2023 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 15.0 }, { "payer_name": "UHC", "plan_name": "UHC Oxford (02-01-2023 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 20.06 }, { "payer_name": "UHC - Adhoc", "plan_name": "UHC - Adhoc All Payer", "methodology": "fee schedule", "standard_charge_dollar": 33.43 }, { "payer_name": "UHC - Adhoc", "plan_name": "UHC - Adhoc Oxford", "methodology": "fee schedule", "standard_charge_dollar": 33.43 }, { "payer_name": "Wellcare", "plan_name": "Wellcare Insurance Exchange", "methodology": "fee schedule", "standard_charge_dollar": 94.15, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 69.74, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup Medicare", "methodology": "fee schedule", "standard_charge_dollar": 69.74, "additional_payer_notes": "100.00% of Medicare Rates" } ] } ] }, { "description": "DILATION & CURETTAGE FOR NON-OBSTETRIC DIAGNOSES - SOI : 4", "code_information": [ { "code": "5174", "type": "APR-DRG" } ], "standard_charges": [ { "setting": "inpatient", "minimum": 31139.11, "maximum": 34253.02, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Better Health - Medi Medi", "methodology": "case rate", "standard_charge_dollar": 34253.02, "additional_payer_notes": "110% of State Medicaid Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Better Health Medicaid", "methodology": "case rate", "standard_charge_dollar": 34253.02, "additional_payer_notes": "110% of State Medicaid Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "case rate", "standard_charge_dollar": 31139.11, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "UBH", "plan_name": "UBH Medicaid", "methodology": "case rate", "standard_charge_dollar": 31139.11, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicaid (02/01/2023 to 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 31761.89, "additional_payer_notes": "102% of State Medicaid Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicaid", "methodology": "case rate", "standard_charge_dollar": 31139.11, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup Medicaid", "methodology": "case rate", "standard_charge_dollar": 31139.11, "additional_payer_notes": "100% of State Medicaid Rates" } ] } ] }, { "description": "Hc Complement Fixation, Each", "code_information": [ { "code": "86171", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 38.0, "discounted_cash": 10.0, "minimum": 6.01, "maximum": 32.3, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 21.22, "additional_payer_notes": "212.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medical Rental Network", "methodology": "fee schedule", "standard_charge_dollar": 21.22, "additional_payer_notes": "212.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 10.01, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "ALLY-ALIGN (FKA SPARTAN PLAN NJ, INC.)", "plan_name": "ALLY-ALIGN (FKA SPARTAN PLAN NJ, INC.)", "methodology": "fee schedule", "standard_charge_dollar": 10.51, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Americhoice (UHC)", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 10.01, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Amerihealth", "plan_name": "Amerihealth Medicare", "methodology": "fee schedule", "standard_charge_dollar": 10.01, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 14.51, "additional_payer_notes": "Laboratory - 145.00% of Medicare Rates" }, { "payer_name": "Clover Health", "plan_name": "Clover Medicare", "methodology": "fee schedule", "standard_charge_dollar": 10.01, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Coventry", "plan_name": "Coventry Auto", "methodology": "fee schedule", "standard_charge_dollar": 20.02, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Coventry", "plan_name": "Coventry Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 20.02, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "fee schedule", "standard_charge_dollar": 14.01, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Fairprice Healthcare Holdings", "plan_name": "Fairprice Healthcare Holdings", "methodology": "fee schedule", "standard_charge_dollar": 12.01, "additional_payer_notes": "Laboratory - 120.00% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ HMO POS", "methodology": "fee schedule", "standard_charge_dollar": 26.83, "additional_payer_notes": "177.30% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ Indemnity", "methodology": "fee schedule", "standard_charge_dollar": 26.83, "additional_payer_notes": "177.30% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ PPO", "methodology": "fee schedule", "standard_charge_dollar": 26.83, "additional_payer_notes": "177.30% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon Medicare", "methodology": "fee schedule", "standard_charge_dollar": 10.01, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Military Tricare", "methodology": "fee schedule", "standard_charge_dollar": 8.01, "additional_payer_notes": "80.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 10.01, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 10.01, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC All Payer (02-01-2023 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 6.01 }, { "payer_name": "UHC", "plan_name": "UHC Medicaid (02/01/2023 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 8.01 }, { "payer_name": "UHC", "plan_name": "UHC Oxford (02-01-2023 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 6.01 }, { "payer_name": "UHC - Adhoc", "plan_name": "UHC - Adhoc All Payer", "methodology": "fee schedule", "standard_charge_dollar": 10.01 }, { "payer_name": "UHC - Adhoc", "plan_name": "UHC - Adhoc Oxford", "methodology": "fee schedule", "standard_charge_dollar": 10.01 }, { "payer_name": "Wellcare", "plan_name": "Wellcare Insurance Exchange", "methodology": "fee schedule", "standard_charge_dollar": 13.51, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 10.01, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup Medicare", "methodology": "fee schedule", "standard_charge_dollar": 10.01, "additional_payer_notes": "100.00% of Medicare Rates" } ] } ] }, { "description": "SKIN ULCERS WITH CC", "code_information": [ { "code": "593", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 15266.0, "minimum": 7052.35, "maximum": 27631.7496, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "case rate", "standard_charge_dollar": 27631.75, "additional_payer_notes": "181.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medical Rental Network", "methodology": "case rate", "standard_charge_dollar": 27631.75, "additional_payer_notes": "181.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "case rate", "standard_charge_dollar": 12565.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "ALLY-ALIGN (FKA SPARTAN PLAN NJ, INC.)", "plan_name": "ALLY-ALIGN (FKA SPARTAN PLAN NJ, INC.)", "methodology": "case rate", "standard_charge_dollar": 16029.47, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Americhoice (UHC)", "plan_name": "UHC Medicare", "methodology": "case rate", "standard_charge_dollar": 12565.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Amerihealth", "plan_name": "Amerihealth Medicare", "methodology": "case rate", "standard_charge_dollar": 12565.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Commercial", "methodology": "case rate", "standard_charge_dollar": 17355.57 }, { "payer_name": "Clover Health", "plan_name": "Clover Medicare", "methodology": "case rate", "standard_charge_dollar": 12565.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Coventry", "plan_name": "Coventry Auto", "methodology": "case rate", "standard_charge_dollar": 25952.47, "additional_payer_notes": "170.00% of Medicare Rates" }, { "payer_name": "Coventry", "plan_name": "Coventry Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 25952.47, "additional_payer_notes": "170.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "case rate", "standard_charge_dollar": 19846.01, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Fairprice Healthcare Holdings", "plan_name": "Fairprice Healthcare Holdings", "methodology": "case rate", "standard_charge_dollar": 24425.86, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon Medicare", "methodology": "case rate", "standard_charge_dollar": 12565.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon NJ Health Medicaid", "methodology": "case rate", "standard_charge_dollar": 7052.35 }, { "payer_name": "Humana", "plan_name": "Humana Military Tricare", "methodology": "case rate", "standard_charge_dollar": 12212.93, "additional_payer_notes": "80.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 15266.16, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 8649.38 }, { "payer_name": "UBH", "plan_name": "UBH Medicare", "methodology": "case rate", "standard_charge_dollar": 12565.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC All Payer (02-01-2023 to 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 19996.27 }, { "payer_name": "UHC", "plan_name": "UHC Oxford (02-01-2023 to 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 17426.75 }, { "payer_name": "UHC - Adhoc", "plan_name": "UHC - Adhoc All Payer", "methodology": "case rate", "standard_charge_dollar": 21226.47 }, { "payer_name": "UHC - Adhoc", "plan_name": "UHC - Adhoc Oxford", "methodology": "case rate", "standard_charge_dollar": 17958.21 }, { "payer_name": "Wellcare", "plan_name": "Wellcare Insurance Exchange", "methodology": "case rate", "standard_charge_dollar": 20609.32, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "case rate", "standard_charge_dollar": 12565.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup Medicare", "methodology": "case rate", "standard_charge_dollar": 12565.0, "additional_payer_notes": "100.00% of Medicare Rates" } ] } ] }, { "description": "KIDNEY AND URINARY TRACT SIGNS AND SYMPTOMS WITH MCC", "code_information": [ { "code": "695", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 14775.0, "minimum": 7172.87, "maximum": 26742.7681, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "case rate", "standard_charge_dollar": 26742.77, "additional_payer_notes": "181.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medical Rental Network", "methodology": "case rate", "standard_charge_dollar": 26742.77, "additional_payer_notes": "181.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "case rate", "standard_charge_dollar": 12170.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "ALLY-ALIGN (FKA SPARTAN PLAN NJ, INC.)", "plan_name": "ALLY-ALIGN (FKA SPARTAN PLAN NJ, INC.)", "methodology": "case rate", "standard_charge_dollar": 15513.76, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Americhoice (UHC)", "plan_name": "UHC Medicare", "methodology": "case rate", "standard_charge_dollar": 12170.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Amerihealth", "plan_name": "Amerihealth Medicare", "methodology": "case rate", "standard_charge_dollar": 12170.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Commercial", "methodology": "case rate", "standard_charge_dollar": 16733.79 }, { "payer_name": "Clover Health", "plan_name": "Clover Medicare", "methodology": "case rate", "standard_charge_dollar": 12170.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Coventry", "plan_name": "Coventry Auto", "methodology": "case rate", "standard_charge_dollar": 25117.52, "additional_payer_notes": "170.00% of Medicare Rates" }, { "payer_name": "Coventry", "plan_name": "Coventry Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 25117.52, "additional_payer_notes": "170.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "case rate", "standard_charge_dollar": 19207.51, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Fairprice Healthcare Holdings", "plan_name": "Fairprice Healthcare Holdings", "methodology": "case rate", "standard_charge_dollar": 23640.02, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon Medicare", "methodology": "case rate", "standard_charge_dollar": 12170.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon NJ Health Medicaid", "methodology": "case rate", "standard_charge_dollar": 7172.87 }, { "payer_name": "Humana", "plan_name": "Humana Military Tricare", "methodology": "case rate", "standard_charge_dollar": 11820.01, "additional_payer_notes": "80.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 14775.01, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 16408.8 }, { "payer_name": "UBH", "plan_name": "UBH Medicare", "methodology": "case rate", "standard_charge_dollar": 12170.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC All Payer (02-01-2023 to 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 19279.89 }, { "payer_name": "UHC", "plan_name": "UHC Oxford (02-01-2023 to 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 16802.42 }, { "payer_name": "UHC - Adhoc", "plan_name": "UHC - Adhoc All Payer", "methodology": "case rate", "standard_charge_dollar": 20466.01 }, { "payer_name": "UHC - Adhoc", "plan_name": "UHC - Adhoc Oxford", "methodology": "case rate", "standard_charge_dollar": 17314.84 }, { "payer_name": "Wellcare", "plan_name": "Wellcare Insurance Exchange", "methodology": "case rate", "standard_charge_dollar": 19946.26, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "case rate", "standard_charge_dollar": 12170.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup Medicare", "methodology": "case rate", "standard_charge_dollar": 12170.7, "additional_payer_notes": "100.00% of Medicare Rates" } ] } ] }, { "description": "Remove Wrist Tendon Lesion - 25111 - OR36025111", "code_information": [ { "code": "25111", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 18275.6, "discounted_cash": 1900.0, "minimum": 1520.776, "maximum": 14620.48, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 4030.06, "additional_payer_notes": "212.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medical Rental Network", "methodology": "fee schedule", "standard_charge_dollar": 4030.06, "additional_payer_notes": "212.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1900.97, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "ALLY-ALIGN (FKA SPARTAN PLAN NJ, INC.)", "plan_name": "ALLY-ALIGN (FKA SPARTAN PLAN NJ, INC.)", "methodology": "fee schedule", "standard_charge_dollar": 1996.02, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Americhoice (UHC)", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1900.97, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Amerihealth", "plan_name": "Amerihealth Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1900.97, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 2793.48, "additional_payer_notes": "146.95% of Medicare Rates" }, { "payer_name": "Clover Health", "plan_name": "Clover Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1900.97, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Coventry", "plan_name": "Coventry Auto", "methodology": "fee schedule", "standard_charge_dollar": 3801.94, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Coventry", "plan_name": "Coventry Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 3801.94, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "fee schedule", "standard_charge_dollar": 2661.36, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Fairprice Healthcare Holdings", "plan_name": "Fairprice Healthcare Holdings", "methodology": "fee schedule", "standard_charge_dollar": 3041.55, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ HMO POS", "methodology": "fee schedule", "standard_charge_dollar": 3370.42, "additional_payer_notes": "177.30% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ Indemnity", "methodology": "fee schedule", "standard_charge_dollar": 3370.42, "additional_payer_notes": "177.30% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ PPO", "methodology": "fee schedule", "standard_charge_dollar": 3370.42, "additional_payer_notes": "177.30% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1900.97, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Military Tricare", "methodology": "fee schedule", "standard_charge_dollar": 1520.78, "additional_payer_notes": "80.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1900.97, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 1900.97, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC All Payer (02-01-2023 to 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 4415.0 }, { "payer_name": "UHC", "plan_name": "UHC Oxford (02-01-2023 to 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 4020.0 }, { "payer_name": "UHC - Adhoc", "plan_name": "UHC - Adhoc All Payer", "methodology": "case rate", "standard_charge_dollar": 4687.0 }, { "payer_name": "UHC - Adhoc", "plan_name": "UHC - Adhoc Oxford", "methodology": "case rate", "standard_charge_dollar": 4143.0 }, { "payer_name": "Wellcare", "plan_name": "Wellcare Insurance Exchange", "methodology": "fee schedule", "standard_charge_dollar": 2566.31, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1900.97, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellchoice", "plan_name": "WELLCHOICE HMO of NJ (Empire) Commercial (HMO / HMO POS, PPO)", "methodology": "case rate", "standard_charge_dollar": 1715.0 }, { "payer_name": "Wellchoice", "plan_name": "WELLCHOICE HMO of NJ (Empire) Commercial (Indemnity)", "methodology": "case rate", "standard_charge_dollar": 1978.0 }, { "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1900.97, "additional_payer_notes": "100.00% of Medicare Rates" } ] } ] }, { "description": "HEADACHES WITH MCC", "code_information": [ { "code": "102", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 14510.0, "minimum": 6722.03, "maximum": 26263.7697, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "case rate", "standard_charge_dollar": 26263.77, "additional_payer_notes": "181.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medical Rental Network", "methodology": "case rate", "standard_charge_dollar": 26263.77, "additional_payer_notes": "181.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "case rate", "standard_charge_dollar": 11958.2, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "ALLY-ALIGN (FKA SPARTAN PLAN NJ, INC.)", "plan_name": "ALLY-ALIGN (FKA SPARTAN PLAN NJ, INC.)", "methodology": "case rate", "standard_charge_dollar": 15235.89, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Americhoice (UHC)", "plan_name": "UHC Medicare", "methodology": "case rate", "standard_charge_dollar": 11958.2, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Amerihealth", "plan_name": "Amerihealth Medicare", "methodology": "case rate", "standard_charge_dollar": 11958.2, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Commercial", "methodology": "case rate", "standard_charge_dollar": 16398.77 }, { "payer_name": "Clover Health", "plan_name": "Clover Medicare", "methodology": "case rate", "standard_charge_dollar": 11958.2, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Coventry", "plan_name": "Coventry Auto", "methodology": "case rate", "standard_charge_dollar": 24667.63, "additional_payer_notes": "170.00% of Medicare Rates" }, { "payer_name": "Coventry", "plan_name": "Coventry Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 24667.63, "additional_payer_notes": "170.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "case rate", "standard_charge_dollar": 18863.48, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Fairprice Healthcare Holdings", "plan_name": "Fairprice Healthcare Holdings", "methodology": "case rate", "standard_charge_dollar": 23216.59, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon Medicare", "methodology": "case rate", "standard_charge_dollar": 11958.2, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon NJ Health Medicaid", "methodology": "case rate", "standard_charge_dollar": 6722.03 }, { "payer_name": "Humana", "plan_name": "Humana Military Tricare", "methodology": "case rate", "standard_charge_dollar": 11608.3, "additional_payer_notes": "80.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 14510.37, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 14777.0 }, { "payer_name": "UBH", "plan_name": "UBH Medicare", "methodology": "case rate", "standard_charge_dollar": 11958.2, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC All Payer (02-01-2023 to 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 18893.89 }, { "payer_name": "UHC", "plan_name": "UHC Oxford (02-01-2023 to 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 16466.02 }, { "payer_name": "UHC - Adhoc", "plan_name": "UHC - Adhoc All Payer", "methodology": "case rate", "standard_charge_dollar": 20056.26 }, { "payer_name": "UHC - Adhoc", "plan_name": "UHC - Adhoc Oxford", "methodology": "case rate", "standard_charge_dollar": 16968.18 }, { "payer_name": "Wellcare", "plan_name": "Wellcare Insurance Exchange", "methodology": "case rate", "standard_charge_dollar": 19589.0, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "case rate", "standard_charge_dollar": 11958.2, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup Medicare", "methodology": "case rate", "standard_charge_dollar": 11958.2, "additional_payer_notes": "100.00% of Medicare Rates" } ] } ] }, { "description": "SYNCOPE & COLLAPSE - SOI : 1", "code_information": [ { "code": "2041", "type": "APR-DRG" } ], "standard_charges": [ { "setting": "inpatient", "minimum": 6911.8, "maximum": 7602.98, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Better Health - Medi Medi", "methodology": "case rate", "standard_charge_dollar": 7602.98, "additional_payer_notes": "110% of State Medicaid Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Better Health Medicaid", "methodology": "case rate", "standard_charge_dollar": 7602.98, "additional_payer_notes": "110% of State Medicaid Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "case rate", "standard_charge_dollar": 6911.8, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "UBH", "plan_name": "UBH Medicaid", "methodology": "case rate", "standard_charge_dollar": 6911.8, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicaid (02/01/2023 to 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 7050.04, "additional_payer_notes": "102% of State Medicaid Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicaid", "methodology": "case rate", "standard_charge_dollar": 6911.8, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup Medicaid", "methodology": "case rate", "standard_charge_dollar": 6911.8, "additional_payer_notes": "100% of State Medicaid Rates" } ] } ] }, { "description": "Hc Assay Of Homocystine", "code_information": [ { "code": "83090", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 309.0, "discounted_cash": 17.0, "minimum": 10.75, "maximum": 262.65, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 37.99, "additional_payer_notes": "212.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medical Rental Network", "methodology": "fee schedule", "standard_charge_dollar": 37.99, "additional_payer_notes": "212.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 17.92, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "ALLY-ALIGN (FKA SPARTAN PLAN NJ, INC.)", "plan_name": "ALLY-ALIGN (FKA SPARTAN PLAN NJ, INC.)", "methodology": "fee schedule", "standard_charge_dollar": 18.82, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Americhoice (UHC)", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 17.92, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Amerihealth", "plan_name": "Amerihealth Medicare", "methodology": "fee schedule", "standard_charge_dollar": 17.92, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 25.98, "additional_payer_notes": "Laboratory - 145.00% of Medicare Rates" }, { "payer_name": "Clover Health", "plan_name": "Clover Medicare", "methodology": "fee schedule", "standard_charge_dollar": 17.92, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Coventry", "plan_name": "Coventry Auto", "methodology": "fee schedule", "standard_charge_dollar": 35.84, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Coventry", "plan_name": "Coventry Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 35.84, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "fee schedule", "standard_charge_dollar": 25.09, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Fairprice Healthcare Holdings", "plan_name": "Fairprice Healthcare Holdings", "methodology": "fee schedule", "standard_charge_dollar": 21.5, "additional_payer_notes": "Laboratory - 120.00% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ HMO POS", "methodology": "fee schedule", "standard_charge_dollar": 218.15, "additional_payer_notes": "177.30% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ Indemnity", "methodology": "fee schedule", "standard_charge_dollar": 218.15, "additional_payer_notes": "177.30% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ PPO", "methodology": "fee schedule", "standard_charge_dollar": 218.15, "additional_payer_notes": "177.30% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon Medicare", "methodology": "fee schedule", "standard_charge_dollar": 17.92, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Military Tricare", "methodology": "fee schedule", "standard_charge_dollar": 14.34, "additional_payer_notes": "80.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 17.92, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 17.92, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC All Payer (02-01-2023 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 10.75 }, { "payer_name": "UHC", "plan_name": "UHC Medicaid (02/01/2023 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 14.34 }, { "payer_name": "UHC", "plan_name": "UHC Oxford (02-01-2023 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 10.75 }, { "payer_name": "UHC - Adhoc", "plan_name": "UHC - Adhoc All Payer", "methodology": "fee schedule", "standard_charge_dollar": 17.92 }, { "payer_name": "UHC - Adhoc", "plan_name": "UHC - Adhoc Oxford", "methodology": "fee schedule", "standard_charge_dollar": 17.92 }, { "payer_name": "Wellcare", "plan_name": "Wellcare Insurance Exchange", "methodology": "fee schedule", "standard_charge_dollar": 24.19, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 17.92, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup Medicare", "methodology": "fee schedule", "standard_charge_dollar": 17.92, "additional_payer_notes": "100.00% of Medicare Rates" } ] } ] }, { "description": "Hc Strapping Of Hip", "code_information": [ { "code": "29520", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 208.36, "discounted_cash": 157.0, "minimum": 39.7759, "maximum": 208.36, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 208.36, "additional_payer_notes": "212.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medical Rental Network", "methodology": "fee schedule", "standard_charge_dollar": 208.36, "additional_payer_notes": "212.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 157.29, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "ALLY-ALIGN (FKA SPARTAN PLAN NJ, INC.)", "plan_name": "ALLY-ALIGN (FKA SPARTAN PLAN NJ, INC.)", "methodology": "fee schedule", "standard_charge_dollar": 165.15, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Americhoice (UHC)", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 157.29, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Amerihealth", "plan_name": "Amerihealth Medicare", "methodology": "fee schedule", "standard_charge_dollar": 157.29, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 208.36, "additional_payer_notes": "146.95% of Medicare Rates" }, { "payer_name": "Clover Health", "plan_name": "Clover Medicare", "methodology": "fee schedule", "standard_charge_dollar": 157.29, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Coventry", "plan_name": "Coventry Auto", "methodology": "fee schedule", "standard_charge_dollar": 208.36, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Coventry", "plan_name": "Coventry Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 208.36, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "fee schedule", "standard_charge_dollar": 208.36, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Fairprice Healthcare Holdings", "plan_name": "Fairprice Healthcare Holdings", "methodology": "fee schedule", "standard_charge_dollar": 208.36, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ HMO POS", "methodology": "fee schedule", "standard_charge_dollar": 208.36, "additional_payer_notes": "177.30% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ Indemnity", "methodology": "fee schedule", "standard_charge_dollar": 208.36, "additional_payer_notes": "177.30% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ PPO", "methodology": "fee schedule", "standard_charge_dollar": 208.36, "additional_payer_notes": "177.30% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon Medicare", "methodology": "fee schedule", "standard_charge_dollar": 157.29, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Military Tricare", "methodology": "fee schedule", "standard_charge_dollar": 125.83, "additional_payer_notes": "80.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 157.29, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 157.29, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC All Payer (02-01-2023 to 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 208.36 }, { "payer_name": "UHC", "plan_name": "UHC Oxford (02-01-2023 to 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 208.36 }, { "payer_name": "UHC - Adhoc", "plan_name": "UHC - Adhoc All Payer", "methodology": "case rate", "standard_charge_dollar": 208.36 }, { "payer_name": "UHC - Adhoc", "plan_name": "UHC - Adhoc Oxford", "methodology": "case rate", "standard_charge_dollar": 208.36 }, { "payer_name": "Wellcare", "plan_name": "Wellcare Insurance Exchange", "methodology": "fee schedule", "standard_charge_dollar": 208.36, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 157.29, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup Medicare", "methodology": "fee schedule", "standard_charge_dollar": 157.29, "additional_payer_notes": "100.00% of Medicare Rates" } ] } ] }, { "description": "COAGULATION & PLATELET DISORDERS - SOI : 4", "code_information": [ { "code": "6614", "type": "APR-DRG" } ], "standard_charges": [ { "setting": "inpatient", "minimum": 29347.35, "maximum": 32282.08, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Better Health - Medi Medi", "methodology": "case rate", "standard_charge_dollar": 32282.08, "additional_payer_notes": "110% of State Medicaid Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Better Health Medicaid", "methodology": "case rate", "standard_charge_dollar": 32282.08, "additional_payer_notes": "110% of State Medicaid Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "case rate", "standard_charge_dollar": 29347.35, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "UBH", "plan_name": "UBH Medicaid", "methodology": "case rate", "standard_charge_dollar": 29347.35, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicaid (02/01/2023 to 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 29934.29, "additional_payer_notes": "102% of State Medicaid Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicaid", "methodology": "case rate", "standard_charge_dollar": 29347.35, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup Medicaid", "methodology": "case rate", "standard_charge_dollar": 29347.35, "additional_payer_notes": "100% of State Medicaid Rates" } ] } ] }, { "description": "OTHER CIRCULATORY SYSTEM DIAGNOSES - SOI : 2", "code_information": [ { "code": "2072", "type": "APR-DRG" } ], "standard_charges": [ { "setting": "inpatient", "minimum": 8320.7, "maximum": 9152.77, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Better Health - Medi Medi", "methodology": "case rate", "standard_charge_dollar": 9152.77, "additional_payer_notes": "110% of State Medicaid Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Better Health Medicaid", "methodology": "case rate", "standard_charge_dollar": 9152.77, "additional_payer_notes": "110% of State Medicaid Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "case rate", "standard_charge_dollar": 8320.7, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "UBH", "plan_name": "UBH Medicaid", "methodology": "case rate", "standard_charge_dollar": 8320.7, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicaid (02/01/2023 to 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 8487.11, "additional_payer_notes": "102% of State Medicaid Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicaid", "methodology": "case rate", "standard_charge_dollar": 8320.7, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup Medicaid", "methodology": "case rate", "standard_charge_dollar": 8320.7, "additional_payer_notes": "100% of State Medicaid Rates" } ] } ] }, { "description": "Hc Immunoassay Analyte Quantitative Nos", "code_information": [ { "code": "83520", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 1737.0, "discounted_cash": 17.0, "minimum": 10.36, "maximum": 1476.45, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 36.61, "additional_payer_notes": "212.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medical Rental Network", "methodology": "fee schedule", "standard_charge_dollar": 36.61, "additional_payer_notes": "212.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 17.27, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "ALLY-ALIGN (FKA SPARTAN PLAN NJ, INC.)", "plan_name": "ALLY-ALIGN (FKA SPARTAN PLAN NJ, INC.)", "methodology": "fee schedule", "standard_charge_dollar": 18.13, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Americhoice (UHC)", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 17.27, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Amerihealth", "plan_name": "Amerihealth Medicare", "methodology": "fee schedule", "standard_charge_dollar": 17.27, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 25.04, "additional_payer_notes": "Laboratory - 145.00% of Medicare Rates" }, { "payer_name": "Clover Health", "plan_name": "Clover Medicare", "methodology": "fee schedule", "standard_charge_dollar": 17.27, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Coventry", "plan_name": "Coventry Auto", "methodology": "fee schedule", "standard_charge_dollar": 34.54, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Coventry", "plan_name": "Coventry Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 34.54, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "fee schedule", "standard_charge_dollar": 24.18, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Fairprice Healthcare Holdings", "plan_name": "Fairprice Healthcare Holdings", "methodology": "fee schedule", "standard_charge_dollar": 20.72, "additional_payer_notes": "Laboratory - 120.00% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ HMO POS", "methodology": "fee schedule", "standard_charge_dollar": 1226.32, "additional_payer_notes": "177.30% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ Indemnity", "methodology": "fee schedule", "standard_charge_dollar": 1226.32, "additional_payer_notes": "177.30% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ PPO", "methodology": "fee schedule", "standard_charge_dollar": 1226.32, "additional_payer_notes": "177.30% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon Medicare", "methodology": "fee schedule", "standard_charge_dollar": 17.27, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Military Tricare", "methodology": "fee schedule", "standard_charge_dollar": 13.82, "additional_payer_notes": "80.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 17.27, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 17.27, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC All Payer (02-01-2023 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 10.36 }, { "payer_name": "UHC", "plan_name": "UHC Medicaid (02/01/2023 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 13.82 }, { "payer_name": "UHC", "plan_name": "UHC Oxford (02-01-2023 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 10.36 }, { "payer_name": "UHC - Adhoc", "plan_name": "UHC - Adhoc All Payer", "methodology": "fee schedule", "standard_charge_dollar": 17.27 }, { "payer_name": "UHC - Adhoc", "plan_name": "UHC - Adhoc Oxford", "methodology": "fee schedule", "standard_charge_dollar": 17.27 }, { "payer_name": "Wellcare", "plan_name": "Wellcare Insurance Exchange", "methodology": "fee schedule", "standard_charge_dollar": 23.31, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 17.27, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup Medicare", "methodology": "fee schedule", "standard_charge_dollar": 17.27, "additional_payer_notes": "100.00% of Medicare Rates" } ] } ] }, { "description": "PERCUTANEOUS CORONARY INTERVENTION WO AMI - SOI : 3", "code_information": [ { "code": "1753", "type": "APR-DRG" } ], "standard_charges": [ { "setting": "inpatient", "minimum": 35599.13, "maximum": 39159.04, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Better Health - Medi Medi", "methodology": "case rate", "standard_charge_dollar": 39159.04, "additional_payer_notes": "110% of State Medicaid Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Better Health Medicaid", "methodology": "case rate", "standard_charge_dollar": 39159.04, "additional_payer_notes": "110% of State Medicaid Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "case rate", "standard_charge_dollar": 35599.13, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "UBH", "plan_name": "UBH Medicaid", "methodology": "case rate", "standard_charge_dollar": 35599.13, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicaid (02/01/2023 to 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 36311.11, "additional_payer_notes": "102% of State Medicaid Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicaid", "methodology": "case rate", "standard_charge_dollar": 35599.13, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup Medicaid", "methodology": "case rate", "standard_charge_dollar": 35599.13, "additional_payer_notes": "100% of State Medicaid Rates" } ] } ] }, { "description": "FEMALE REPRODUCTIVE SYSTEM MALIGNANCY - SOI : 2", "code_information": [ { "code": "5302", "type": "APR-DRG" } ], "standard_charges": [ { "setting": "inpatient", "minimum": 9023.21, "maximum": 9925.53, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Better Health - Medi Medi", "methodology": "case rate", "standard_charge_dollar": 9925.53, "additional_payer_notes": "110% of State Medicaid Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Better Health Medicaid", "methodology": "case rate", "standard_charge_dollar": 9925.53, "additional_payer_notes": "110% of State Medicaid Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "case rate", "standard_charge_dollar": 9023.21, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "UBH", "plan_name": "UBH Medicaid", "methodology": "case rate", "standard_charge_dollar": 9023.21, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicaid (02/01/2023 to 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 9203.67, "additional_payer_notes": "102% of State Medicaid Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicaid", "methodology": "case rate", "standard_charge_dollar": 9023.21, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup Medicaid", "methodology": "case rate", "standard_charge_dollar": 9023.21, "additional_payer_notes": "100% of State Medicaid Rates" } ] } ] }, { "description": "OTHER DIGESTIVE SYSTEM O.R. PROCEDURES WITHOUT CCMCC", "code_information": [ { "code": "358", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 17711.0, "minimum": 8419.24, "maximum": 32057.8331, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "case rate", "standard_charge_dollar": 32057.83, "additional_payer_notes": "181.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medical Rental Network", "methodology": "case rate", "standard_charge_dollar": 32057.83, "additional_payer_notes": "181.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "case rate", "standard_charge_dollar": 14528.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "ALLY-ALIGN (FKA SPARTAN PLAN NJ, INC.)", "plan_name": "ALLY-ALIGN (FKA SPARTAN PLAN NJ, INC.)", "methodology": "case rate", "standard_charge_dollar": 18597.09, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Americhoice (UHC)", "plan_name": "UHC Medicare", "methodology": "case rate", "standard_charge_dollar": 14528.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Amerihealth", "plan_name": "Amerihealth Medicare", "methodology": "case rate", "standard_charge_dollar": 14528.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Commercial", "methodology": "case rate", "standard_charge_dollar": 20451.28 }, { "payer_name": "Clover Health", "plan_name": "Clover Medicare", "methodology": "case rate", "standard_charge_dollar": 14528.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Coventry", "plan_name": "Coventry Auto", "methodology": "case rate", "standard_charge_dollar": 30109.57, "additional_payer_notes": "170.00% of Medicare Rates" }, { "payer_name": "Coventry", "plan_name": "Coventry Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 30109.57, "additional_payer_notes": "170.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "case rate", "standard_charge_dollar": 23024.96, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Fairprice Healthcare Holdings", "plan_name": "Fairprice Healthcare Holdings", "methodology": "case rate", "standard_charge_dollar": 28338.42, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon Medicare", "methodology": "case rate", "standard_charge_dollar": 14528.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon NJ Health Medicaid", "methodology": "case rate", "standard_charge_dollar": 8419.24 }, { "payer_name": "Humana", "plan_name": "Humana Military Tricare", "methodology": "case rate", "standard_charge_dollar": 14169.21, "additional_payer_notes": "80.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 17711.51, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 17639.5 }, { "payer_name": "UBH", "plan_name": "UBH Medicare", "methodology": "case rate", "standard_charge_dollar": 14528.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC All Payer (02-01-2023 to 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 23563.0 }, { "payer_name": "UHC", "plan_name": "UHC Oxford (02-01-2023 to 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 20535.15 }, { "payer_name": "UHC - Adhoc", "plan_name": "UHC - Adhoc All Payer", "methodology": "case rate", "standard_charge_dollar": 25012.62 }, { "payer_name": "UHC - Adhoc", "plan_name": "UHC - Adhoc Oxford", "methodology": "case rate", "standard_charge_dollar": 21161.41 }, { "payer_name": "Wellcare", "plan_name": "Wellcare Insurance Exchange", "methodology": "case rate", "standard_charge_dollar": 23910.54, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "case rate", "standard_charge_dollar": 14528.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup Medicare", "methodology": "case rate", "standard_charge_dollar": 14528.6, "additional_payer_notes": "100.00% of Medicare Rates" } ] } ] }, { "description": "Hc Colonoscpy,Flex,W/Dir Submuc Inject", "code_information": [ { "code": "45381", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 4898.95, "discounted_cash": 1414.0, "minimum": 935.2096, "maximum": 4164.1075, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 2999.1, "additional_payer_notes": "212.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medical Rental Network", "methodology": "fee schedule", "standard_charge_dollar": 2999.1, "additional_payer_notes": "212.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1414.67, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "ALLY-ALIGN (FKA SPARTAN PLAN NJ, INC.)", "plan_name": "ALLY-ALIGN (FKA SPARTAN PLAN NJ, INC.)", "methodology": "fee schedule", "standard_charge_dollar": 1485.4, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Americhoice (UHC)", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1414.67, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Amerihealth", "plan_name": "Amerihealth Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1414.67, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 2078.86, "additional_payer_notes": "146.95% of Medicare Rates" }, { "payer_name": "Clover Health", "plan_name": "Clover Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1414.67, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Coventry", "plan_name": "Coventry Auto", "methodology": "fee schedule", "standard_charge_dollar": 2829.34, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Coventry", "plan_name": "Coventry Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 2829.34, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "fee schedule", "standard_charge_dollar": 1980.54, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Fairprice Healthcare Holdings", "plan_name": "Fairprice Healthcare Holdings", "methodology": "fee schedule", "standard_charge_dollar": 2263.47, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ HMO POS", "methodology": "fee schedule", "standard_charge_dollar": 2508.21, "additional_payer_notes": "177.30% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ Indemnity", "methodology": "fee schedule", "standard_charge_dollar": 2508.21, "additional_payer_notes": "177.30% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ PPO", "methodology": "fee schedule", "standard_charge_dollar": 2508.21, "additional_payer_notes": "177.30% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1414.67, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon NJ Health Medicaid", "methodology": "percent of total billed charges", "standard_charge_percentage": 19.58, "median_amount": 959.21, "10th_percentile": 959.21, "90th_percentile": 959.21, "count": "1 through 10" }, { "payer_name": "Humana", "plan_name": "Humana Military Tricare", "methodology": "fee schedule", "standard_charge_dollar": 1131.74, "additional_payer_notes": "80.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1414.67, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 1414.67, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC All Payer (02-01-2023 to 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 3912.0 }, { "payer_name": "UHC", "plan_name": "UHC Oxford (02-01-2023 to 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 3676.0 }, { "payer_name": "UHC - Adhoc", "plan_name": "UHC - Adhoc All Payer", "methodology": "case rate", "standard_charge_dollar": 4153.0 }, { "payer_name": "UHC - Adhoc", "plan_name": "UHC - Adhoc Oxford", "methodology": "case rate", "standard_charge_dollar": 3788.0 }, { "payer_name": "Wellcare", "plan_name": "Wellcare Insurance Exchange", "methodology": "fee schedule", "standard_charge_dollar": 1909.8, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1414.67, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup Medicaid", "methodology": "percent of total billed charges", "standard_charge_percentage": 19.09, "median_amount": 913.65, "10th_percentile": 913.65, "90th_percentile": 913.65, "count": "1 through 10" }, { "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1414.67, "additional_payer_notes": "100.00% of Medicare Rates" } ] } ] }, { "description": "Hc Insert Intrvas Vc Filtr W Vasc Acs Vssl Rs&I", "code_information": [ { "code": "37191", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 22560.0, "discounted_cash": 6578.0, "minimum": 2472.0, "maximum": 18048.0, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 13946.12, "additional_payer_notes": "212.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medical Rental Network", "methodology": "fee schedule", "standard_charge_dollar": 13946.12, "additional_payer_notes": "212.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 6578.36, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "ALLY-ALIGN (FKA SPARTAN PLAN NJ, INC.)", "plan_name": "ALLY-ALIGN (FKA SPARTAN PLAN NJ, INC.)", "methodology": "fee schedule", "standard_charge_dollar": 6907.28, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Americhoice (UHC)", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 6578.36, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Amerihealth", "plan_name": "Amerihealth Medicare", "methodology": "fee schedule", "standard_charge_dollar": 6578.36, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 9666.9, "additional_payer_notes": "146.95% of Medicare Rates" }, { "payer_name": "Clover Health", "plan_name": "Clover Medicare", "methodology": "fee schedule", "standard_charge_dollar": 6578.36, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Coventry", "plan_name": "Coventry Auto", "methodology": "fee schedule", "standard_charge_dollar": 13156.72, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Coventry", "plan_name": "Coventry Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 13156.72, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "fee schedule", "standard_charge_dollar": 9209.7, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Fairprice Healthcare Holdings", "plan_name": "Fairprice Healthcare Holdings", "methodology": "fee schedule", "standard_charge_dollar": 10525.38, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ HMO POS", "methodology": "fee schedule", "standard_charge_dollar": 11663.43, "additional_payer_notes": "177.30% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ Indemnity", "methodology": "fee schedule", "standard_charge_dollar": 11663.43, "additional_payer_notes": "177.30% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ PPO", "methodology": "fee schedule", "standard_charge_dollar": 11663.43, "additional_payer_notes": "177.30% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon Medicare", "methodology": "fee schedule", "standard_charge_dollar": 6578.36, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Military Tricare", "methodology": "fee schedule", "standard_charge_dollar": 5262.69, "additional_payer_notes": "80.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 6578.36, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 6578.36, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC All Payer (02-01-2023 to 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 6624.0 }, { "payer_name": "UHC", "plan_name": "UHC Oxford (02-01-2023 to 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 6317.0 }, { "payer_name": "UHC - Adhoc", "plan_name": "UHC - Adhoc All Payer", "methodology": "case rate", "standard_charge_dollar": 7031.0 }, { "payer_name": "UHC - Adhoc", "plan_name": "UHC - Adhoc Oxford", "methodology": "case rate", "standard_charge_dollar": 6510.0 }, { "payer_name": "Wellcare", "plan_name": "Wellcare Insurance Exchange", "methodology": "fee schedule", "standard_charge_dollar": 8880.79, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 6578.36, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellchoice", "plan_name": "WELLCHOICE HMO of NJ (Empire) Commercial (HMO / HMO POS, PPO)", "methodology": "case rate", "standard_charge_dollar": 2472.0 }, { "payer_name": "Wellchoice", "plan_name": "WELLCHOICE HMO of NJ (Empire) Commercial (Indemnity)", "methodology": "case rate", "standard_charge_dollar": 2753.0 }, { "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup Medicare", "methodology": "fee schedule", "standard_charge_dollar": 6578.36, "additional_payer_notes": "100.00% of Medicare Rates" } ] } ] }, { "description": "Hc Decalcify Tissue", "code_information": [ { "code": "88311", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 63.0, "minimum": 5.41, "maximum": 53.55, "payers_information": [ { "payer_name": "UHC", "plan_name": "UHC All Payer (02-01-2023 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 5.41 }, { "payer_name": "UHC", "plan_name": "UHC Medicaid (02/01/2023 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 16.38 }, { "payer_name": "UHC", "plan_name": "UHC Oxford (02-01-2023 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 5.41 }, { "payer_name": "UHC - Adhoc", "plan_name": "UHC - Adhoc All Payer", "methodology": "fee schedule", "standard_charge_dollar": 9.02 }, { "payer_name": "UHC - Adhoc", "plan_name": "UHC - Adhoc Oxford", "methodology": "fee schedule", "standard_charge_dollar": 9.02 }, { "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup Medicaid", "methodology": "percent of total billed charges", "standard_charge_percentage": 19.09, "median_amount": 11.75, "10th_percentile": 11.75, "90th_percentile": 11.75, "count": "1 through 10" } ] } ] }, { "description": "OTHER MALE REPRODUCTIVE SYSTEM DIAGNOSES WITHOUT CCMCC", "code_information": [ { "code": "730", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 9322.0, "minimum": 3549.28, "maximum": 16874.0327, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "case rate", "standard_charge_dollar": 16874.03, "additional_payer_notes": "181.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medical Rental Network", "methodology": "case rate", "standard_charge_dollar": 16874.03, "additional_payer_notes": "181.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "case rate", "standard_charge_dollar": 7792.56, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "ALLY-ALIGN (FKA SPARTAN PLAN NJ, INC.)", "plan_name": "ALLY-ALIGN (FKA SPARTAN PLAN NJ, INC.)", "methodology": "case rate", "standard_charge_dollar": 9788.8, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Americhoice (UHC)", "plan_name": "UHC Medicare", "methodology": "case rate", "standard_charge_dollar": 7792.56, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Amerihealth", "plan_name": "Amerihealth Medicare", "methodology": "case rate", "standard_charge_dollar": 7792.56, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Commercial", "methodology": "case rate", "standard_charge_dollar": 9831.36 }, { "payer_name": "Clover Health", "plan_name": "Clover Medicare", "methodology": "case rate", "standard_charge_dollar": 7792.56, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Coventry", "plan_name": "Coventry Auto", "methodology": "case rate", "standard_charge_dollar": 15848.54, "additional_payer_notes": "170.00% of Medicare Rates" }, { "payer_name": "Coventry", "plan_name": "Coventry Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 15848.54, "additional_payer_notes": "170.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "case rate", "standard_charge_dollar": 12119.47, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Fairprice Healthcare Holdings", "plan_name": "Fairprice Healthcare Holdings", "methodology": "case rate", "standard_charge_dollar": 14916.27, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon Medicare", "methodology": "case rate", "standard_charge_dollar": 7792.56, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon NJ Health Medicaid", "methodology": "case rate", "standard_charge_dollar": 3549.28 }, { "payer_name": "Humana", "plan_name": "Humana Military Tricare", "methodology": "case rate", "standard_charge_dollar": 7458.14, "additional_payer_notes": "80.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 9322.67, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 4618.94 }, { "payer_name": "UBH", "plan_name": "UBH Medicare", "methodology": "case rate", "standard_charge_dollar": 7792.56, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC All Payer (02-01-2023 to 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 11327.23 }, { "payer_name": "UHC", "plan_name": "UHC Oxford (02-01-2023 to 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 9871.68 }, { "payer_name": "UHC - Adhoc", "plan_name": "UHC - Adhoc All Payer", "methodology": "case rate", "standard_charge_dollar": 12024.1 }, { "payer_name": "UHC - Adhoc", "plan_name": "UHC - Adhoc Oxford", "methodology": "case rate", "standard_charge_dollar": 10172.74 }, { "payer_name": "Wellcare", "plan_name": "Wellcare Insurance Exchange", "methodology": "case rate", "standard_charge_dollar": 12585.6, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "case rate", "standard_charge_dollar": 7792.56, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup Medicare", "methodology": "case rate", "standard_charge_dollar": 7792.56, "additional_payer_notes": "100.00% of Medicare Rates" } ] } ] }, { "description": "Hc App Skn Sub Head/Hnd/Ft/Gnt >=100Sqcm Ea Ad 100Sqcm", "code_information": [ { "code": "15278", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 1065.5, "minimum": 203.404, "maximum": 1065.5, "payers_information": [ { "payer_name": "UHC", "plan_name": "UHC All Payer (02-01-2023 to 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 1065.5 }, { "payer_name": "UHC", "plan_name": "UHC Oxford (02-01-2023 to 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 1065.5 }, { "payer_name": "UHC - Adhoc", "plan_name": "UHC - Adhoc All Payer", "methodology": "case rate", "standard_charge_dollar": 1065.5 }, { "payer_name": "UHC - Adhoc", "plan_name": "UHC - Adhoc Oxford", "methodology": "case rate", "standard_charge_dollar": 1065.5 }, { "payer_name": "Wellchoice", "plan_name": "WELLCHOICE HMO of NJ (Empire) Commercial (HMO / HMO POS, PPO)", "methodology": "case rate", "standard_charge_dollar": 1065.5 }, { "payer_name": "Wellchoice", "plan_name": "WELLCHOICE HMO of NJ (Empire) Commercial (Indemnity)", "methodology": "case rate", "standard_charge_dollar": 1065.5 } ] } ] }, { "description": "MAJOR LARGE BOWEL PROCEDURES - SOI : 1", "code_information": [ { "code": "2311", "type": "APR-DRG" } ], "standard_charges": [ { "setting": "inpatient", "minimum": 19063.44, "maximum": 20969.78, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Better Health - Medi Medi", "methodology": "case rate", "standard_charge_dollar": 20969.78, "additional_payer_notes": "110% of State Medicaid Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Better Health Medicaid", "methodology": "case rate", "standard_charge_dollar": 20969.78, "additional_payer_notes": "110% of State Medicaid Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "case rate", "standard_charge_dollar": 19063.44, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "UBH", "plan_name": "UBH Medicaid", "methodology": "case rate", "standard_charge_dollar": 19063.44, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicaid (02/01/2023 to 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 19444.7, "additional_payer_notes": "102% of State Medicaid Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicaid", "methodology": "case rate", "standard_charge_dollar": 19063.44, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup Medicaid", "methodology": "case rate", "standard_charge_dollar": 19063.44, "additional_payer_notes": "100% of State Medicaid Rates" } ] } ] }, { "description": "Hc Molecular Pathology Procedure Level 5", "code_information": [ { "code": "81404", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 1374.15, "discounted_cash": 274.0, "minimum": 164.9, "maximum": 1168.0275, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 582.64, "additional_payer_notes": "212.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medical Rental Network", "methodology": "fee schedule", "standard_charge_dollar": 582.64, "additional_payer_notes": "212.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 274.83, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "ALLY-ALIGN (FKA SPARTAN PLAN NJ, INC.)", "plan_name": "ALLY-ALIGN (FKA SPARTAN PLAN NJ, INC.)", "methodology": "fee schedule", "standard_charge_dollar": 288.57, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Americhoice (UHC)", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 274.83, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Amerihealth", "plan_name": "Amerihealth Medicare", "methodology": "fee schedule", "standard_charge_dollar": 274.83, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 398.5, "additional_payer_notes": "A Indicator - 155.00% of Medicare Rates" }, { "payer_name": "Clover Health", "plan_name": "Clover Medicare", "methodology": "fee schedule", "standard_charge_dollar": 274.83, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Coventry", "plan_name": "Coventry Auto", "methodology": "fee schedule", "standard_charge_dollar": 549.66, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Coventry", "plan_name": "Coventry Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 549.66, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "fee schedule", "standard_charge_dollar": 384.76, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Fairprice Healthcare Holdings", "plan_name": "Fairprice Healthcare Holdings", "methodology": "fee schedule", "standard_charge_dollar": 329.8, "additional_payer_notes": "Laboratory - 120.00% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ HMO POS", "methodology": "fee schedule", "standard_charge_dollar": 970.15, "additional_payer_notes": "177.30% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ Indemnity", "methodology": "fee schedule", "standard_charge_dollar": 970.15, "additional_payer_notes": "177.30% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ PPO", "methodology": "fee schedule", "standard_charge_dollar": 970.15, "additional_payer_notes": "177.30% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon Medicare", "methodology": "fee schedule", "standard_charge_dollar": 274.83, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Military Tricare", "methodology": "fee schedule", "standard_charge_dollar": 219.86, "additional_payer_notes": "80.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 274.83, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 274.83, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC All Payer (02-01-2023 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 164.9 }, { "payer_name": "UHC", "plan_name": "UHC Medicaid (02/01/2023 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 219.86 }, { "payer_name": "UHC", "plan_name": "UHC Oxford (02-01-2023 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 164.9 }, { "payer_name": "UHC - Adhoc", "plan_name": "UHC - Adhoc All Payer", "methodology": "fee schedule", "standard_charge_dollar": 274.83 }, { "payer_name": "UHC - Adhoc", "plan_name": "UHC - Adhoc Oxford", "methodology": "fee schedule", "standard_charge_dollar": 274.83 }, { "payer_name": "Wellcare", "plan_name": "Wellcare Insurance Exchange", "methodology": "fee schedule", "standard_charge_dollar": 371.02, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 274.83, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup Medicare", "methodology": "fee schedule", "standard_charge_dollar": 274.83, "additional_payer_notes": "100.00% of Medicare Rates" } ] } ] }, { "description": "Hc Chem Cautery Granulatn Tissue", "code_information": [ { "code": "17250", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 821.86, "discounted_cash": 237.0, "minimum": 156.8931, "maximum": 821.86, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 502.82, "additional_payer_notes": "212.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medical Rental Network", "methodology": "fee schedule", "standard_charge_dollar": 502.82, "additional_payer_notes": "212.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 237.18, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "ALLY-ALIGN (FKA SPARTAN PLAN NJ, INC.)", "plan_name": "ALLY-ALIGN (FKA SPARTAN PLAN NJ, INC.)", "methodology": "fee schedule", "standard_charge_dollar": 249.04, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Americhoice (UHC)", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 237.18, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Amerihealth", "plan_name": "Amerihealth Medicare", "methodology": "fee schedule", "standard_charge_dollar": 237.18, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 348.54, "additional_payer_notes": "146.95% of Medicare Rates" }, { "payer_name": "Clover Health", "plan_name": "Clover Medicare", "methodology": "fee schedule", "standard_charge_dollar": 237.18, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Coventry", "plan_name": "Coventry Auto", "methodology": "fee schedule", "standard_charge_dollar": 474.36, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Coventry", "plan_name": "Coventry Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 474.36, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "fee schedule", "standard_charge_dollar": 332.05, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Fairprice Healthcare Holdings", "plan_name": "Fairprice Healthcare Holdings", "methodology": "fee schedule", "standard_charge_dollar": 379.49, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ HMO POS", "methodology": "fee schedule", "standard_charge_dollar": 420.52, "additional_payer_notes": "177.30% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ Indemnity", "methodology": "fee schedule", "standard_charge_dollar": 420.52, "additional_payer_notes": "177.30% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ PPO", "methodology": "fee schedule", "standard_charge_dollar": 420.52, "additional_payer_notes": "177.30% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon Medicare", "methodology": "fee schedule", "standard_charge_dollar": 237.18, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Military Tricare", "methodology": "fee schedule", "standard_charge_dollar": 189.74, "additional_payer_notes": "80.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 237.18, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 237.18, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC All Payer (02-01-2023 to 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 821.86 }, { "payer_name": "UHC", "plan_name": "UHC Oxford (02-01-2023 to 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 821.86 }, { "payer_name": "UHC - Adhoc", "plan_name": "UHC - Adhoc All Payer", "methodology": "case rate", "standard_charge_dollar": 821.86 }, { "payer_name": "UHC - Adhoc", "plan_name": "UHC - Adhoc Oxford", "methodology": "case rate", "standard_charge_dollar": 821.86 }, { "payer_name": "Wellcare", "plan_name": "Wellcare Insurance Exchange", "methodology": "fee schedule", "standard_charge_dollar": 320.19, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 237.18, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellchoice", "plan_name": "WELLCHOICE HMO of NJ (Empire) Commercial (HMO / HMO POS, PPO)", "methodology": "case rate", "standard_charge_dollar": 821.86 }, { "payer_name": "Wellchoice", "plan_name": "WELLCHOICE HMO of NJ (Empire) Commercial (Indemnity)", "methodology": "case rate", "standard_charge_dollar": 821.86 }, { "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup Medicare", "methodology": "fee schedule", "standard_charge_dollar": 237.18, "additional_payer_notes": "100.00% of Medicare Rates" } ] } ] }, { "description": "NEONATE, TRANSFERRED < 5 DAYS OLD, BORN HERE - SOI : 4", "code_information": [ { "code": "5814", "type": "APR-DRG" } ], "standard_charges": [ { "setting": "inpatient", "minimum": 4985.94, "maximum": 5484.53, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Better Health - Medi Medi", "methodology": "case rate", "standard_charge_dollar": 5484.53, "additional_payer_notes": "110% of State Medicaid Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Better Health Medicaid", "methodology": "case rate", "standard_charge_dollar": 5484.53, "additional_payer_notes": "110% of State Medicaid Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "case rate", "standard_charge_dollar": 4985.94, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "UBH", "plan_name": "UBH Medicaid", "methodology": "case rate", "standard_charge_dollar": 4985.94, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicaid (02/01/2023 to 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 5085.65, "additional_payer_notes": "102% of State Medicaid Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicaid", "methodology": "case rate", "standard_charge_dollar": 4985.94, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup Medicaid", "methodology": "case rate", "standard_charge_dollar": 4985.94, "additional_payer_notes": "100% of State Medicaid Rates" } ] } ] }, { "description": "Hc Clsd Treat Tarsal Fx Wo Manip Ea", "code_information": [ { "code": "28450", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 839.01, "discounted_cash": 291.0, "minimum": 160.167, "maximum": 839.01, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 618.19, "additional_payer_notes": "212.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medical Rental Network", "methodology": "fee schedule", "standard_charge_dollar": 618.19, "additional_payer_notes": "212.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 291.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "ALLY-ALIGN (FKA SPARTAN PLAN NJ, INC.)", "plan_name": "ALLY-ALIGN (FKA SPARTAN PLAN NJ, INC.)", "methodology": "fee schedule", "standard_charge_dollar": 306.18, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Americhoice (UHC)", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 291.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Amerihealth", "plan_name": "Amerihealth Medicare", "methodology": "fee schedule", "standard_charge_dollar": 291.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 428.51, "additional_payer_notes": "146.95% of Medicare Rates" }, { "payer_name": "Clover Health", "plan_name": "Clover Medicare", "methodology": "fee schedule", "standard_charge_dollar": 291.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Coventry", "plan_name": "Coventry Auto", "methodology": "fee schedule", "standard_charge_dollar": 583.2, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Coventry", "plan_name": "Coventry Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 583.2, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "fee schedule", "standard_charge_dollar": 408.24, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Fairprice Healthcare Holdings", "plan_name": "Fairprice Healthcare Holdings", "methodology": "fee schedule", "standard_charge_dollar": 466.56, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ HMO POS", "methodology": "fee schedule", "standard_charge_dollar": 517.01, "additional_payer_notes": "177.30% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ Indemnity", "methodology": "fee schedule", "standard_charge_dollar": 517.01, "additional_payer_notes": "177.30% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ PPO", "methodology": "fee schedule", "standard_charge_dollar": 517.01, "additional_payer_notes": "177.30% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon Medicare", "methodology": "fee schedule", "standard_charge_dollar": 291.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Military Tricare", "methodology": "fee schedule", "standard_charge_dollar": 233.28, "additional_payer_notes": "80.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 291.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 291.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC All Payer (02-01-2023 to 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 839.01 }, { "payer_name": "UHC", "plan_name": "UHC Oxford (02-01-2023 to 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 839.01 }, { "payer_name": "UHC - Adhoc", "plan_name": "UHC - Adhoc All Payer", "methodology": "case rate", "standard_charge_dollar": 839.01 }, { "payer_name": "UHC - Adhoc", "plan_name": "UHC - Adhoc Oxford", "methodology": "case rate", "standard_charge_dollar": 839.01 }, { "payer_name": "Wellcare", "plan_name": "Wellcare Insurance Exchange", "methodology": "fee schedule", "standard_charge_dollar": 393.66, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 291.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup Medicare", "methodology": "fee schedule", "standard_charge_dollar": 291.6, "additional_payer_notes": "100.00% of Medicare Rates" } ] } ] }, { "description": "Incision of midfoot bones", "code_information": [ { "code": "28304", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 11001.47, "discounted_cash": 8578.0, "minimum": 1715.0, "maximum": 11001.47, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 11001.47, "additional_payer_notes": "212.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medical Rental Network", "methodology": "fee schedule", "standard_charge_dollar": 11001.47, "additional_payer_notes": "212.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 8578.33, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "ALLY-ALIGN (FKA SPARTAN PLAN NJ, INC.)", "plan_name": "ALLY-ALIGN (FKA SPARTAN PLAN NJ, INC.)", "methodology": "fee schedule", "standard_charge_dollar": 9007.25, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Americhoice (UHC)", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 8578.33, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Amerihealth", "plan_name": "Amerihealth Medicare", "methodology": "fee schedule", "standard_charge_dollar": 8578.33, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 11001.47, "additional_payer_notes": "146.95% of Medicare Rates" }, { "payer_name": "Clover Health", "plan_name": "Clover Medicare", "methodology": "fee schedule", "standard_charge_dollar": 8578.33, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Coventry", "plan_name": "Coventry Auto", "methodology": "fee schedule", "standard_charge_dollar": 11001.47, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Coventry", "plan_name": "Coventry Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 11001.47, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "fee schedule", "standard_charge_dollar": 11001.47, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Fairprice Healthcare Holdings", "plan_name": "Fairprice Healthcare Holdings", "methodology": "fee schedule", "standard_charge_dollar": 11001.47, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ HMO POS", "methodology": "fee schedule", "standard_charge_dollar": 11001.47, "additional_payer_notes": "177.30% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ Indemnity", "methodology": "fee schedule", "standard_charge_dollar": 11001.47, "additional_payer_notes": "177.30% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ PPO", "methodology": "fee schedule", "standard_charge_dollar": 11001.47, "additional_payer_notes": "177.30% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon Medicare", "methodology": "fee schedule", "standard_charge_dollar": 8578.33, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Military Tricare", "methodology": "fee schedule", "standard_charge_dollar": 6862.66, "additional_payer_notes": "80.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 8578.33, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 8578.33, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC All Payer (02-01-2023 to 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 6624.0 }, { "payer_name": "UHC", "plan_name": "UHC Oxford (02-01-2023 to 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 6317.0 }, { "payer_name": "UHC - Adhoc", "plan_name": "UHC - Adhoc All Payer", "methodology": "case rate", "standard_charge_dollar": 7031.0 }, { "payer_name": "UHC - Adhoc", "plan_name": "UHC - Adhoc Oxford", "methodology": "case rate", "standard_charge_dollar": 6510.0 }, { "payer_name": "Wellcare", "plan_name": "Wellcare Insurance Exchange", "methodology": "fee schedule", "standard_charge_dollar": 11001.47, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 8578.33, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellchoice", "plan_name": "WELLCHOICE HMO of NJ (Empire) Commercial (HMO / HMO POS, PPO)", "methodology": "case rate", "standard_charge_dollar": 1715.0 }, { "payer_name": "Wellchoice", "plan_name": "WELLCHOICE HMO of NJ (Empire) Commercial (Indemnity)", "methodology": "case rate", "standard_charge_dollar": 1978.0 }, { "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup Medicare", "methodology": "fee schedule", "standard_charge_dollar": 8578.33, "additional_payer_notes": "100.00% of Medicare Rates" } ] } ] }, { "description": "OTHER PROCEDURES FOR ENDOCRINE, NUTRITIONAL & METABOLIC DISORDERS - SOI : 2", "code_information": [ { "code": "4052", "type": "APR-DRG" } ], "standard_charges": [ { "setting": "inpatient", "minimum": 18302.93, "maximum": 20133.22, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Better Health - Medi Medi", "methodology": "case rate", "standard_charge_dollar": 20133.22, "additional_payer_notes": "110% of State Medicaid Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Better Health Medicaid", "methodology": "case rate", "standard_charge_dollar": 20133.22, "additional_payer_notes": "110% of State Medicaid Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "case rate", "standard_charge_dollar": 18302.93, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "UBH", "plan_name": "UBH Medicaid", "methodology": "case rate", "standard_charge_dollar": 18302.93, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicaid (02/01/2023 to 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 18668.99, "additional_payer_notes": "102% of State Medicaid Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicaid", "methodology": "case rate", "standard_charge_dollar": 18302.93, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup Medicaid", "methodology": "case rate", "standard_charge_dollar": 18302.93, "additional_payer_notes": "100% of State Medicaid Rates" } ] } ] }, { "description": "POST-OP, POST-TRAUMA, OTHER DEVICE INFECTIONS W O.R. PROCEDURE - SOI : 2", "code_information": [ { "code": "7112", "type": "APR-DRG" } ], "standard_charges": [ { "setting": "inpatient", "minimum": 17052.59, "maximum": 18757.84, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Better Health - Medi Medi", "methodology": "case rate", "standard_charge_dollar": 18757.84, "additional_payer_notes": "110% of State Medicaid Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Better Health Medicaid", "methodology": "case rate", "standard_charge_dollar": 18757.84, "additional_payer_notes": "110% of State Medicaid Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "case rate", "standard_charge_dollar": 17052.59, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "UBH", "plan_name": "UBH Medicaid", "methodology": "case rate", "standard_charge_dollar": 17052.59, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicaid (02/01/2023 to 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 17393.64, "additional_payer_notes": "102% of State Medicaid Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicaid", "methodology": "case rate", "standard_charge_dollar": 17052.59, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup Medicaid", "methodology": "case rate", "standard_charge_dollar": 17052.59, "additional_payer_notes": "100% of State Medicaid Rates" } ] } ] }, { "description": "Removal Of Lens Material - 66840 - OR36066840", "code_information": [ { "code": "66840", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 15390.0, "discounted_cash": 2728.0, "minimum": 1715.0, "maximum": 12312.0, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 5784.04, "additional_payer_notes": "212.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medical Rental Network", "methodology": "fee schedule", "standard_charge_dollar": 5784.04, "additional_payer_notes": "212.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2728.32, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "ALLY-ALIGN (FKA SPARTAN PLAN NJ, INC.)", "plan_name": "ALLY-ALIGN (FKA SPARTAN PLAN NJ, INC.)", "methodology": "fee schedule", "standard_charge_dollar": 2864.74, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Americhoice (UHC)", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2728.32, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Amerihealth", "plan_name": "Amerihealth Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2728.32, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 4009.27, "additional_payer_notes": "146.95% of Medicare Rates" }, { "payer_name": "Clover Health", "plan_name": "Clover Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2728.32, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Coventry", "plan_name": "Coventry Auto", "methodology": "fee schedule", "standard_charge_dollar": 5456.64, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Coventry", "plan_name": "Coventry Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 5456.64, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "fee schedule", "standard_charge_dollar": 3819.65, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Fairprice Healthcare Holdings", "plan_name": "Fairprice Healthcare Holdings", "methodology": "fee schedule", "standard_charge_dollar": 4365.31, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ HMO POS", "methodology": "fee schedule", "standard_charge_dollar": 4837.31, "additional_payer_notes": "177.30% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ Indemnity", "methodology": "fee schedule", "standard_charge_dollar": 4837.31, "additional_payer_notes": "177.30% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ PPO", "methodology": "fee schedule", "standard_charge_dollar": 4837.31, "additional_payer_notes": "177.30% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2728.32, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Military Tricare", "methodology": "fee schedule", "standard_charge_dollar": 2182.66, "additional_payer_notes": "80.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2728.32, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 2728.32, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC All Payer (02-01-2023 to 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 4415.0 }, { "payer_name": "UHC", "plan_name": "UHC Oxford (02-01-2023 to 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 4020.0 }, { "payer_name": "UHC - Adhoc", "plan_name": "UHC - Adhoc All Payer", "methodology": "case rate", "standard_charge_dollar": 4687.0 }, { "payer_name": "UHC - Adhoc", "plan_name": "UHC - Adhoc Oxford", "methodology": "case rate", "standard_charge_dollar": 4143.0 }, { "payer_name": "Wellcare", "plan_name": "Wellcare Insurance Exchange", "methodology": "fee schedule", "standard_charge_dollar": 3683.23, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2728.32, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellchoice", "plan_name": "WELLCHOICE HMO of NJ (Empire) Commercial (HMO / HMO POS, PPO)", "methodology": "case rate", "standard_charge_dollar": 1715.0 }, { "payer_name": "Wellchoice", "plan_name": "WELLCHOICE HMO of NJ (Empire) Commercial (Indemnity)", "methodology": "case rate", "standard_charge_dollar": 1978.0 }, { "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2728.32, "additional_payer_notes": "100.00% of Medicare Rates" } ] } ] }, { "description": "MINOR BLADDER PROCEDURES WITH CC", "code_information": [ { "code": "663", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 19124.0, "minimum": 10242.58, "maximum": 34616.0147, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "case rate", "standard_charge_dollar": 34616.01, "additional_payer_notes": "181.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medical Rental Network", "methodology": "case rate", "standard_charge_dollar": 34616.01, "additional_payer_notes": "181.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "case rate", "standard_charge_dollar": 15663.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "ALLY-ALIGN (FKA SPARTAN PLAN NJ, INC.)", "plan_name": "ALLY-ALIGN (FKA SPARTAN PLAN NJ, INC.)", "methodology": "case rate", "standard_charge_dollar": 20081.11, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Americhoice (UHC)", "plan_name": "UHC Medicare", "methodology": "case rate", "standard_charge_dollar": 15663.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Amerihealth", "plan_name": "Amerihealth Medicare", "methodology": "case rate", "standard_charge_dollar": 15663.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Commercial", "methodology": "case rate", "standard_charge_dollar": 22240.53 }, { "payer_name": "Clover Health", "plan_name": "Clover Medicare", "methodology": "case rate", "standard_charge_dollar": 15663.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Coventry", "plan_name": "Coventry Auto", "methodology": "case rate", "standard_charge_dollar": 32512.28, "additional_payer_notes": "170.00% of Medicare Rates" }, { "payer_name": "Coventry", "plan_name": "Coventry Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 32512.28, "additional_payer_notes": "170.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "case rate", "standard_charge_dollar": 24862.33, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Fairprice Healthcare Holdings", "plan_name": "Fairprice Healthcare Holdings", "methodology": "case rate", "standard_charge_dollar": 30599.79, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon Medicare", "methodology": "case rate", "standard_charge_dollar": 15663.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon NJ Health Medicaid", "methodology": "case rate", "standard_charge_dollar": 10242.58 }, { "payer_name": "Humana", "plan_name": "Humana Military Tricare", "methodology": "case rate", "standard_charge_dollar": 15299.9, "additional_payer_notes": "80.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 19124.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 17262.1 }, { "payer_name": "UBH", "plan_name": "UBH Medicare", "methodology": "case rate", "standard_charge_dollar": 15663.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC All Payer (02-01-2023 to 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 25624.49 }, { "payer_name": "UHC", "plan_name": "UHC Oxford (02-01-2023 to 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 22331.74 }, { "payer_name": "UHC - Adhoc", "plan_name": "UHC - Adhoc All Payer", "methodology": "case rate", "standard_charge_dollar": 27200.94 }, { "payer_name": "UHC - Adhoc", "plan_name": "UHC - Adhoc Oxford", "methodology": "case rate", "standard_charge_dollar": 23012.79 }, { "payer_name": "Wellcare", "plan_name": "Wellcare Insurance Exchange", "methodology": "case rate", "standard_charge_dollar": 25818.57, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "case rate", "standard_charge_dollar": 15663.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup Medicare", "methodology": "case rate", "standard_charge_dollar": 15663.5, "additional_payer_notes": "100.00% of Medicare Rates" } ] } ] }, { "description": "OTHER MUSCULOSKELETAL SYSTEM AND CONNECTIVE TISSUE DIAGNOSES WITH MCC", "code_information": [ { "code": "564", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 19395.0, "minimum": 9817.34, "maximum": 35105.4749, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "case rate", "standard_charge_dollar": 35105.47, "additional_payer_notes": "181.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medical Rental Network", "methodology": "case rate", "standard_charge_dollar": 35105.47, "additional_payer_notes": "181.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "case rate", "standard_charge_dollar": 15880.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "ALLY-ALIGN (FKA SPARTAN PLAN NJ, INC.)", "plan_name": "ALLY-ALIGN (FKA SPARTAN PLAN NJ, INC.)", "methodology": "case rate", "standard_charge_dollar": 20365.05, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Americhoice (UHC)", "plan_name": "UHC Medicare", "methodology": "case rate", "standard_charge_dollar": 15880.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Amerihealth", "plan_name": "Amerihealth Medicare", "methodology": "case rate", "standard_charge_dollar": 15880.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Commercial", "methodology": "case rate", "standard_charge_dollar": 22582.87 }, { "payer_name": "Clover Health", "plan_name": "Clover Medicare", "methodology": "case rate", "standard_charge_dollar": 15880.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Coventry", "plan_name": "Coventry Auto", "methodology": "case rate", "standard_charge_dollar": 32971.99, "additional_payer_notes": "170.00% of Medicare Rates" }, { "payer_name": "Coventry", "plan_name": "Coventry Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 32971.99, "additional_payer_notes": "170.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "case rate", "standard_charge_dollar": 25213.88, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Fairprice Healthcare Holdings", "plan_name": "Fairprice Healthcare Holdings", "methodology": "case rate", "standard_charge_dollar": 31032.46, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon Medicare", "methodology": "case rate", "standard_charge_dollar": 15880.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon NJ Health Medicaid", "methodology": "case rate", "standard_charge_dollar": 9817.34 }, { "payer_name": "Humana", "plan_name": "Humana Military Tricare", "methodology": "case rate", "standard_charge_dollar": 15516.23, "additional_payer_notes": "80.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 19395.29, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 23640.0 }, { "payer_name": "UBH", "plan_name": "UBH Medicare", "methodology": "case rate", "standard_charge_dollar": 15880.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC All Payer (02-01-2023 to 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 26018.92 }, { "payer_name": "UHC", "plan_name": "UHC Oxford (02-01-2023 to 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 22675.48 }, { "payer_name": "UHC - Adhoc", "plan_name": "UHC - Adhoc All Payer", "methodology": "case rate", "standard_charge_dollar": 27619.63 }, { "payer_name": "UHC - Adhoc", "plan_name": "UHC - Adhoc Oxford", "methodology": "case rate", "standard_charge_dollar": 23367.02 }, { "payer_name": "Wellcare", "plan_name": "Wellcare Insurance Exchange", "methodology": "case rate", "standard_charge_dollar": 26183.64, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "case rate", "standard_charge_dollar": 15880.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup Medicare", "methodology": "case rate", "standard_charge_dollar": 15880.6, "additional_payer_notes": "100.00% of Medicare Rates" } ] } ] }, { "description": "KIDNEY & URINARY TRACT PROCEDURES FOR MALIGNANCY - SOI : 3", "code_information": [ { "code": "4423", "type": "APR-DRG" } ], "standard_charges": [ { "setting": "inpatient", "minimum": 29141.08, "maximum": 32055.19, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Better Health - Medi Medi", "methodology": "case rate", "standard_charge_dollar": 32055.19, "additional_payer_notes": "110% of State Medicaid Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Better Health Medicaid", "methodology": "case rate", "standard_charge_dollar": 32055.19, "additional_payer_notes": "110% of State Medicaid Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "case rate", "standard_charge_dollar": 29141.08, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "UBH", "plan_name": "UBH Medicaid", "methodology": "case rate", "standard_charge_dollar": 29141.08, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicaid (02/01/2023 to 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 29723.9, "additional_payer_notes": "102% of State Medicaid Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicaid", "methodology": "case rate", "standard_charge_dollar": 29141.08, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup Medicaid", "methodology": "case rate", "standard_charge_dollar": 29141.08, "additional_payer_notes": "100% of State Medicaid Rates" } ] } ] }, { "description": "Hc Iadna Hiv-1 Quant & Reverse Transcription", "code_information": [ { "code": "87536", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 348.0, "discounted_cash": 85.0, "minimum": 51.06, "maximum": 295.8, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 180.41, "additional_payer_notes": "212.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medical Rental Network", "methodology": "fee schedule", "standard_charge_dollar": 180.41, "additional_payer_notes": "212.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 85.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "ALLY-ALIGN (FKA SPARTAN PLAN NJ, INC.)", "plan_name": "ALLY-ALIGN (FKA SPARTAN PLAN NJ, INC.)", "methodology": "fee schedule", "standard_charge_dollar": 89.36, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Americhoice (UHC)", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 85.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Amerihealth", "plan_name": "Amerihealth Medicare", "methodology": "fee schedule", "standard_charge_dollar": 85.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 123.4, "additional_payer_notes": "Laboratory - 145.00% of Medicare Rates" }, { "payer_name": "Clover Health", "plan_name": "Clover Medicare", "methodology": "fee schedule", "standard_charge_dollar": 85.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Coventry", "plan_name": "Coventry Auto", "methodology": "fee schedule", "standard_charge_dollar": 170.2, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Coventry", "plan_name": "Coventry Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 170.2, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "fee schedule", "standard_charge_dollar": 119.14, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Fairprice Healthcare Holdings", "plan_name": "Fairprice Healthcare Holdings", "methodology": "fee schedule", "standard_charge_dollar": 102.12, "additional_payer_notes": "Laboratory - 120.00% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ HMO POS", "methodology": "fee schedule", "standard_charge_dollar": 245.69, "additional_payer_notes": "177.30% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ Indemnity", "methodology": "fee schedule", "standard_charge_dollar": 245.69, "additional_payer_notes": "177.30% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ PPO", "methodology": "fee schedule", "standard_charge_dollar": 245.69, "additional_payer_notes": "177.30% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon Medicare", "methodology": "fee schedule", "standard_charge_dollar": 85.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Military Tricare", "methodology": "fee schedule", "standard_charge_dollar": 68.08, "additional_payer_notes": "80.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 85.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 85.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC All Payer (02-01-2023 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 51.06 }, { "payer_name": "UHC", "plan_name": "UHC Medicaid (02/01/2023 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 68.08 }, { "payer_name": "UHC", "plan_name": "UHC Oxford (02-01-2023 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 51.06 }, { "payer_name": "UHC - Adhoc", "plan_name": "UHC - Adhoc All Payer", "methodology": "fee schedule", "standard_charge_dollar": 85.1 }, { "payer_name": "UHC - Adhoc", "plan_name": "UHC - Adhoc Oxford", "methodology": "fee schedule", "standard_charge_dollar": 85.1 }, { "payer_name": "Wellcare", "plan_name": "Wellcare Insurance Exchange", "methodology": "fee schedule", "standard_charge_dollar": 114.89, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 85.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup Medicare", "methodology": "fee schedule", "standard_charge_dollar": 85.1, "additional_payer_notes": "100.00% of Medicare Rates" } ] } ] }, { "description": "UTERINE & ADNEXA PROCEDURES FOR LEIOMYOMA - SOI : 2", "code_information": [ { "code": "5192", "type": "APR-DRG" } ], "standard_charges": [ { "setting": "inpatient", "minimum": 14778.74, "maximum": 16256.62, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Better Health - Medi Medi", "methodology": "case rate", "standard_charge_dollar": 16256.62, "additional_payer_notes": "110% of State Medicaid Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Better Health Medicaid", "methodology": "case rate", "standard_charge_dollar": 16256.62, "additional_payer_notes": "110% of State Medicaid Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "case rate", "standard_charge_dollar": 14778.74, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "UBH", "plan_name": "UBH Medicaid", "methodology": "case rate", "standard_charge_dollar": 14778.74, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicaid (02/01/2023 to 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 15074.32, "additional_payer_notes": "102% of State Medicaid Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicaid", "methodology": "case rate", "standard_charge_dollar": 14778.74, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup Medicaid", "methodology": "case rate", "standard_charge_dollar": 14778.74, "additional_payer_notes": "100% of State Medicaid Rates" } ] } ] }, { "description": "Hc Irrigat Corpus Cavern,Priapism", "code_information": [ { "code": "54220", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 1014.59, "discounted_cash": 295.0, "minimum": 193.6852, "maximum": 1014.59, "payers_information": [ { "payer_name": "Humana", "plan_name": "Humana Military Tricare", "methodology": "fee schedule", "standard_charge_dollar": 236.3, "additional_payer_notes": "80.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 295.37, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 295.37, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC All Payer (02-01-2023 to 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 1014.59 }, { "payer_name": "UHC", "plan_name": "UHC Oxford (02-01-2023 to 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 1014.59 }, { "payer_name": "UHC - Adhoc", "plan_name": "UHC - Adhoc All Payer", "methodology": "case rate", "standard_charge_dollar": 1014.59 }, { "payer_name": "UHC - Adhoc", "plan_name": "UHC - Adhoc Oxford", "methodology": "case rate", "standard_charge_dollar": 1014.59 }, { "payer_name": "Wellcare", "plan_name": "Wellcare Insurance Exchange", "methodology": "fee schedule", "standard_charge_dollar": 398.75, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 295.37, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellchoice", "plan_name": "WELLCHOICE HMO of NJ (Empire) Commercial (HMO / HMO POS, PPO)", "methodology": "case rate", "standard_charge_dollar": 1014.59 }, { "payer_name": "Wellchoice", "plan_name": "WELLCHOICE HMO of NJ (Empire) Commercial (Indemnity)", "methodology": "case rate", "standard_charge_dollar": 1014.59 }, { "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup Medicare", "methodology": "fee schedule", "standard_charge_dollar": 295.37, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 626.18, "additional_payer_notes": "212.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medical Rental Network", "methodology": "fee schedule", "standard_charge_dollar": 626.18, "additional_payer_notes": "212.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 295.37, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "ALLY-ALIGN (FKA SPARTAN PLAN NJ, INC.)", "plan_name": "ALLY-ALIGN (FKA SPARTAN PLAN NJ, INC.)", "methodology": "fee schedule", "standard_charge_dollar": 310.14, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Americhoice (UHC)", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 295.37, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Amerihealth", "plan_name": "Amerihealth Medicare", "methodology": "fee schedule", "standard_charge_dollar": 295.37, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 434.05, "additional_payer_notes": "146.95% of Medicare Rates" }, { "payer_name": "Clover Health", "plan_name": "Clover Medicare", "methodology": "fee schedule", "standard_charge_dollar": 295.37, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Coventry", "plan_name": "Coventry Auto", "methodology": "fee schedule", "standard_charge_dollar": 590.74, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Coventry", "plan_name": "Coventry Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 590.74, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "fee schedule", "standard_charge_dollar": 413.52, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Fairprice Healthcare Holdings", "plan_name": "Fairprice Healthcare Holdings", "methodology": "fee schedule", "standard_charge_dollar": 472.59, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ HMO POS", "methodology": "fee schedule", "standard_charge_dollar": 523.69, "additional_payer_notes": "177.30% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ Indemnity", "methodology": "fee schedule", "standard_charge_dollar": 523.69, "additional_payer_notes": "177.30% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ PPO", "methodology": "fee schedule", "standard_charge_dollar": 523.69, "additional_payer_notes": "177.30% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon Medicare", "methodology": "fee schedule", "standard_charge_dollar": 295.37, "additional_payer_notes": "100.00% of Medicare Rates" } ] } ] }, { "description": "KIDNEY TRANSPLANT WITH HEMODIALYSIS WITHOUT MCC", "code_information": [ { "code": "651", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 44382.0, "minimum": 35506.152, "maximum": 177381.0, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "case rate", "standard_charge_dollar": 80332.67, "additional_payer_notes": "181.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medical Rental Network", "methodology": "case rate", "standard_charge_dollar": 80332.67, "additional_payer_notes": "181.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "case rate", "standard_charge_dollar": 35944.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "ALLY-ALIGN (FKA SPARTAN PLAN NJ, INC.)", "plan_name": "ALLY-ALIGN (FKA SPARTAN PLAN NJ, INC.)", "methodology": "case rate", "standard_charge_dollar": 46601.82, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Americhoice (UHC)", "plan_name": "UHC Medicare", "methodology": "case rate", "standard_charge_dollar": 35944.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Amerihealth", "plan_name": "Amerihealth Medicare", "methodology": "case rate", "standard_charge_dollar": 35944.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Commercial", "methodology": "case rate", "standard_charge_dollar": 54215.85 }, { "payer_name": "Clover Health", "plan_name": "Clover Medicare", "methodology": "case rate", "standard_charge_dollar": 35944.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Coventry", "plan_name": "Coventry Auto", "methodology": "case rate", "standard_charge_dollar": 75450.57, "additional_payer_notes": "170.00% of Medicare Rates" }, { "payer_name": "Coventry", "plan_name": "Coventry Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 75450.57, "additional_payer_notes": "170.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "case rate", "standard_charge_dollar": 57697.5, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Fairprice Healthcare Holdings", "plan_name": "Fairprice Healthcare Holdings", "methodology": "case rate", "standard_charge_dollar": 71012.3, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon Medicare", "methodology": "case rate", "standard_charge_dollar": 35944.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Military Tricare", "methodology": "case rate", "standard_charge_dollar": 35506.15, "additional_payer_notes": "80.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 44382.69, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 177381.0 }, { "payer_name": "UBH", "plan_name": "UBH Medicare", "methodology": "case rate", "standard_charge_dollar": 35944.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC All Payer (02-01-2023 to 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 62464.96 }, { "payer_name": "UHC", "plan_name": "UHC Oxford (02-01-2023 to 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 54438.2 }, { "payer_name": "UHC - Adhoc", "plan_name": "UHC - Adhoc All Payer", "methodology": "case rate", "standard_charge_dollar": 66307.88 }, { "payer_name": "UHC - Adhoc", "plan_name": "UHC - Adhoc Oxford", "methodology": "case rate", "standard_charge_dollar": 56098.4 }, { "payer_name": "Wellcare", "plan_name": "Wellcare Insurance Exchange", "methodology": "case rate", "standard_charge_dollar": 59916.63, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "case rate", "standard_charge_dollar": 35944.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup Medicare", "methodology": "case rate", "standard_charge_dollar": 35944.8, "additional_payer_notes": "100.00% of Medicare Rates" } ] } ] }, { "description": "Hc Blood Typing, Rh (D)", "code_information": [ { "code": "86901", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 164.61, "discounted_cash": 44.0, "minimum": 1.79, "maximum": 139.9185, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 93.6, "additional_payer_notes": "212.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medical Rental Network", "methodology": "fee schedule", "standard_charge_dollar": 93.6, "additional_payer_notes": "212.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 44.15, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "ALLY-ALIGN (FKA SPARTAN PLAN NJ, INC.)", "plan_name": "ALLY-ALIGN (FKA SPARTAN PLAN NJ, INC.)", "methodology": "fee schedule", "standard_charge_dollar": 46.36, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Americhoice (UHC)", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 44.15, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Amerihealth", "plan_name": "Amerihealth Medicare", "methodology": "fee schedule", "standard_charge_dollar": 44.15, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 64.88, "additional_payer_notes": "Laboratory - 145.00% of Medicare Rates" }, { "payer_name": "Clover Health", "plan_name": "Clover Medicare", "methodology": "fee schedule", "standard_charge_dollar": 44.15, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Coventry", "plan_name": "Coventry Auto", "methodology": "fee schedule", "standard_charge_dollar": 88.3, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Coventry", "plan_name": "Coventry Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 88.3, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "fee schedule", "standard_charge_dollar": 61.81, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Fairprice Healthcare Holdings", "plan_name": "Fairprice Healthcare Holdings", "methodology": "fee schedule", "standard_charge_dollar": 70.64, "additional_payer_notes": "Laboratory - 120.00% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ HMO POS", "methodology": "fee schedule", "standard_charge_dollar": 78.28, "additional_payer_notes": "177.30% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ Indemnity", "methodology": "fee schedule", "standard_charge_dollar": 78.28, "additional_payer_notes": "177.30% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ PPO", "methodology": "fee schedule", "standard_charge_dollar": 78.28, "additional_payer_notes": "177.30% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon Medicare", "methodology": "fee schedule", "standard_charge_dollar": 44.15, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Military Tricare", "methodology": "fee schedule", "standard_charge_dollar": 35.32, "additional_payer_notes": "80.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 44.15, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 44.15, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC All Payer (02-01-2023 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 1.79 }, { "payer_name": "UHC", "plan_name": "UHC Medicaid (02/01/2023 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 2.39 }, { "payer_name": "UHC", "plan_name": "UHC Oxford (02-01-2023 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 1.79 }, { "payer_name": "UHC - Adhoc", "plan_name": "UHC - Adhoc All Payer", "methodology": "fee schedule", "standard_charge_dollar": 2.99 }, { "payer_name": "UHC - Adhoc", "plan_name": "UHC - Adhoc Oxford", "methodology": "fee schedule", "standard_charge_dollar": 2.99 }, { "payer_name": "Wellcare", "plan_name": "Wellcare Insurance Exchange", "methodology": "fee schedule", "standard_charge_dollar": 59.6, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 44.15, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup Medicaid", "methodology": "percent of total billed charges", "standard_charge_percentage": 19.09, "median_amount": 30.7, "10th_percentile": 17.07, "90th_percentile": 30.7, "count": "68" }, { "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup Medicare", "methodology": "fee schedule", "standard_charge_dollar": 44.15, "additional_payer_notes": "100.00% of Medicare Rates" } ] } ] }, { "description": "Hc Egd Balloon Dilation Esophagus <30 Mm Diam", "code_information": [ { "code": "43249", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 7811.63, "discounted_cash": 2268.0, "minimum": 1491.2402, "maximum": 6639.8855, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 4809.3, "additional_payer_notes": "212.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medical Rental Network", "methodology": "fee schedule", "standard_charge_dollar": 4809.3, "additional_payer_notes": "212.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2268.54, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "ALLY-ALIGN (FKA SPARTAN PLAN NJ, INC.)", "plan_name": "ALLY-ALIGN (FKA SPARTAN PLAN NJ, INC.)", "methodology": "fee schedule", "standard_charge_dollar": 2381.97, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Americhoice (UHC)", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2268.54, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Amerihealth", "plan_name": "Amerihealth Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2268.54, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 3333.62, "additional_payer_notes": "146.95% of Medicare Rates" }, { "payer_name": "Clover Health", "plan_name": "Clover Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2268.54, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Coventry", "plan_name": "Coventry Auto", "methodology": "fee schedule", "standard_charge_dollar": 4537.08, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Coventry", "plan_name": "Coventry Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 4537.08, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "fee schedule", "standard_charge_dollar": 3175.96, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Fairprice Healthcare Holdings", "plan_name": "Fairprice Healthcare Holdings", "methodology": "fee schedule", "standard_charge_dollar": 3629.66, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ HMO POS", "methodology": "fee schedule", "standard_charge_dollar": 4022.12, "additional_payer_notes": "177.30% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ Indemnity", "methodology": "fee schedule", "standard_charge_dollar": 4022.12, "additional_payer_notes": "177.30% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ PPO", "methodology": "fee schedule", "standard_charge_dollar": 4022.12, "additional_payer_notes": "177.30% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2268.54, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon NJ Health Medicaid", "methodology": "percent of total billed charges", "standard_charge_percentage": 19.58, "median_amount": 1529.52, "10th_percentile": 1452.2, "90th_percentile": 1529.52, "count": "1 through 10" }, { "payer_name": "Humana", "plan_name": "Humana Military Tricare", "methodology": "fee schedule", "standard_charge_dollar": 1814.83, "additional_payer_notes": "80.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2268.54, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 2268.54, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC All Payer (02-01-2023 to 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 3912.0 }, { "payer_name": "UHC", "plan_name": "UHC Oxford (02-01-2023 to 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 3676.0 }, { "payer_name": "UHC - Adhoc", "plan_name": "UHC - Adhoc All Payer", "methodology": "case rate", "standard_charge_dollar": 4153.0 }, { "payer_name": "UHC - Adhoc", "plan_name": "UHC - Adhoc Oxford", "methodology": "case rate", "standard_charge_dollar": 3788.0 }, { "payer_name": "Wellcare", "plan_name": "Wellcare Insurance Exchange", "methodology": "fee schedule", "standard_charge_dollar": 3062.53, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2268.54, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2268.54, "additional_payer_notes": "100.00% of Medicare Rates" } ] } ] }, { "description": "MALFUNCTION, REACTION, COMPLIC OF ORTHOPEDIC DEVICE OR PROCEDURE - SOI : 2", "code_information": [ { "code": "3492", "type": "APR-DRG" } ], "standard_charges": [ { "setting": "inpatient", "minimum": 9358.36, "maximum": 10294.2, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Better Health - Medi Medi", "methodology": "case rate", "standard_charge_dollar": 10294.2, "additional_payer_notes": "110% of State Medicaid Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Better Health Medicaid", "methodology": "case rate", "standard_charge_dollar": 10294.2, "additional_payer_notes": "110% of State Medicaid Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "case rate", "standard_charge_dollar": 9358.36, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "UBH", "plan_name": "UBH Medicaid", "methodology": "case rate", "standard_charge_dollar": 9358.36, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicaid (02/01/2023 to 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 9545.53, "additional_payer_notes": "102% of State Medicaid Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicaid", "methodology": "case rate", "standard_charge_dollar": 9358.36, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup Medicaid", "methodology": "case rate", "standard_charge_dollar": 9358.36, "additional_payer_notes": "100% of State Medicaid Rates" } ] } ] }, { "description": "PERITONEAL ADHESIOLYSIS WITH CC", "code_information": [ { "code": "336", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 25925.0, "minimum": 14350.73, "maximum": 46925.7885, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "case rate", "standard_charge_dollar": 46925.79, "additional_payer_notes": "181.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medical Rental Network", "methodology": "case rate", "standard_charge_dollar": 46925.79, "additional_payer_notes": "181.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "case rate", "standard_charge_dollar": 21124.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "ALLY-ALIGN (FKA SPARTAN PLAN NJ, INC.)", "plan_name": "ALLY-ALIGN (FKA SPARTAN PLAN NJ, INC.)", "methodology": "case rate", "standard_charge_dollar": 27222.14, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Americhoice (UHC)", "plan_name": "UHC Medicare", "methodology": "case rate", "standard_charge_dollar": 21124.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Amerihealth", "plan_name": "Amerihealth Medicare", "methodology": "case rate", "standard_charge_dollar": 21124.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Commercial", "methodology": "case rate", "standard_charge_dollar": 30850.28 }, { "payer_name": "Clover Health", "plan_name": "Clover Medicare", "methodology": "case rate", "standard_charge_dollar": 21124.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Coventry", "plan_name": "Coventry Auto", "methodology": "case rate", "standard_charge_dollar": 44073.95, "additional_payer_notes": "170.00% of Medicare Rates" }, { "payer_name": "Coventry", "plan_name": "Coventry Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 44073.95, "additional_payer_notes": "170.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "case rate", "standard_charge_dollar": 33703.61, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Fairprice Healthcare Holdings", "plan_name": "Fairprice Healthcare Holdings", "methodology": "case rate", "standard_charge_dollar": 41481.36, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon Medicare", "methodology": "case rate", "standard_charge_dollar": 21124.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon NJ Health Medicaid", "methodology": "case rate", "standard_charge_dollar": 14350.73 }, { "payer_name": "Humana", "plan_name": "Humana Military Tricare", "methodology": "case rate", "standard_charge_dollar": 20740.68, "additional_payer_notes": "80.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 25925.85, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 24870.7 }, { "payer_name": "UBH", "plan_name": "UBH Medicare", "methodology": "case rate", "standard_charge_dollar": 21124.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC All Payer (02-01-2023 to 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 35544.25 }, { "payer_name": "UHC", "plan_name": "UHC Oxford (02-01-2023 to 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 30976.8 }, { "payer_name": "UHC - Adhoc", "plan_name": "UHC - Adhoc All Payer", "methodology": "case rate", "standard_charge_dollar": 37730.97 }, { "payer_name": "UHC - Adhoc", "plan_name": "UHC - Adhoc Oxford", "methodology": "case rate", "standard_charge_dollar": 31921.5 }, { "payer_name": "Wellcare", "plan_name": "Wellcare Insurance Exchange", "methodology": "case rate", "standard_charge_dollar": 34999.9, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "case rate", "standard_charge_dollar": 21124.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup Medicare", "methodology": "case rate", "standard_charge_dollar": 21124.5, "additional_payer_notes": "100.00% of Medicare Rates" } ] } ] }, { "description": "Hc Oxycodone Screening - G0480 - 30100024", "code_information": [ { "code": "G0480", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 431.0, "discounted_cash": 114.0, "minimum": 8.3996, "maximum": 754.8, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 242.59, "additional_payer_notes": "212.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medical Rental Network", "methodology": "fee schedule", "standard_charge_dollar": 242.59, "additional_payer_notes": "212.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 114.43, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "ALLY-ALIGN (FKA SPARTAN PLAN NJ, INC.)", "plan_name": "ALLY-ALIGN (FKA SPARTAN PLAN NJ, INC.)", "methodology": "fee schedule", "standard_charge_dollar": 120.15, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Americhoice (UHC)", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 114.43, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Amerihealth", "plan_name": "Amerihealth Medicare", "methodology": "fee schedule", "standard_charge_dollar": 114.43, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 165.92, "additional_payer_notes": "Laboratory - 145.00% of Medicare Rates" }, { "payer_name": "Clover Health", "plan_name": "Clover Medicare", "methodology": "fee schedule", "standard_charge_dollar": 114.43, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Coventry", "plan_name": "Coventry Auto", "methodology": "fee schedule", "standard_charge_dollar": 228.86, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Coventry", "plan_name": "Coventry Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 228.86, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "fee schedule", "standard_charge_dollar": 160.2, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Fairprice Healthcare Holdings", "plan_name": "Fairprice Healthcare Holdings", "methodology": "fee schedule", "standard_charge_dollar": 137.32, "additional_payer_notes": "Laboratory - 120.00% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ HMO POS", "methodology": "fee schedule", "standard_charge_dollar": 304.29, "additional_payer_notes": "177.30% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ Indemnity", "methodology": "fee schedule", "standard_charge_dollar": 304.29, "additional_payer_notes": "177.30% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ PPO", "methodology": "fee schedule", "standard_charge_dollar": 304.29, "additional_payer_notes": "177.30% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon Medicare", "methodology": "fee schedule", "standard_charge_dollar": 114.43, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Military Tricare", "methodology": "fee schedule", "standard_charge_dollar": 91.54, "additional_payer_notes": "80.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 114.43, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 114.43, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC All Payer (02-01-2023 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 68.66 }, { "payer_name": "UHC", "plan_name": "UHC Medicaid (02/01/2023 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 91.54 }, { "payer_name": "UHC", "plan_name": "UHC Oxford (02-01-2023 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 68.66 }, { "payer_name": "UHC - Adhoc", "plan_name": "UHC - Adhoc All Payer", "methodology": "fee schedule", "standard_charge_dollar": 114.43 }, { "payer_name": "UHC - Adhoc", "plan_name": "UHC - Adhoc Oxford", "methodology": "fee schedule", "standard_charge_dollar": 114.43 }, { "payer_name": "Wellcare", "plan_name": "Wellcare Insurance Exchange", "methodology": "fee schedule", "standard_charge_dollar": 154.48, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 114.43, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup Medicare", "methodology": "fee schedule", "standard_charge_dollar": 114.43, "additional_payer_notes": "100.00% of Medicare Rates" } ] } ] }, { "description": "Hc Antibiotic Sens,Agar Diffusn,Ea", "code_information": [ { "code": "87181", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 19.0, "discounted_cash": 4.0, "minimum": 2.85, "maximum": 16.15, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 10.07, "additional_payer_notes": "212.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medical Rental Network", "methodology": "fee schedule", "standard_charge_dollar": 10.07, "additional_payer_notes": "212.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 4.75, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "ALLY-ALIGN (FKA SPARTAN PLAN NJ, INC.)", "plan_name": "ALLY-ALIGN (FKA SPARTAN PLAN NJ, INC.)", "methodology": "fee schedule", "standard_charge_dollar": 4.99, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Americhoice (UHC)", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 4.75, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Amerihealth", "plan_name": "Amerihealth Medicare", "methodology": "fee schedule", "standard_charge_dollar": 4.75, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 6.89, "additional_payer_notes": "Laboratory - 145.00% of Medicare Rates" }, { "payer_name": "Clover Health", "plan_name": "Clover Medicare", "methodology": "fee schedule", "standard_charge_dollar": 4.75, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Coventry", "plan_name": "Coventry Auto", "methodology": "fee schedule", "standard_charge_dollar": 9.5, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Coventry", "plan_name": "Coventry Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 9.5, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "fee schedule", "standard_charge_dollar": 6.65, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Fairprice Healthcare Holdings", "plan_name": "Fairprice Healthcare Holdings", "methodology": "fee schedule", "standard_charge_dollar": 5.7, "additional_payer_notes": "Laboratory - 120.00% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ HMO POS", "methodology": "fee schedule", "standard_charge_dollar": 13.41, "additional_payer_notes": "177.30% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ Indemnity", "methodology": "fee schedule", "standard_charge_dollar": 13.41, "additional_payer_notes": "177.30% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ PPO", "methodology": "fee schedule", "standard_charge_dollar": 13.41, "additional_payer_notes": "177.30% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon Medicare", "methodology": "fee schedule", "standard_charge_dollar": 4.75, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Military Tricare", "methodology": "fee schedule", "standard_charge_dollar": 3.8, "additional_payer_notes": "80.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 4.75, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 4.75, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC All Payer (02-01-2023 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 2.85 }, { "payer_name": "UHC", "plan_name": "UHC Medicaid (02/01/2023 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 3.8 }, { "payer_name": "UHC", "plan_name": "UHC Oxford (02-01-2023 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 2.85 }, { "payer_name": "UHC - Adhoc", "plan_name": "UHC - Adhoc All Payer", "methodology": "fee schedule", "standard_charge_dollar": 4.75 }, { "payer_name": "UHC - Adhoc", "plan_name": "UHC - Adhoc Oxford", "methodology": "fee schedule", "standard_charge_dollar": 4.75 }, { "payer_name": "Wellcare", "plan_name": "Wellcare Insurance Exchange", "methodology": "fee schedule", "standard_charge_dollar": 6.41, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 4.75, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup Medicare", "methodology": "fee schedule", "standard_charge_dollar": 4.75, "additional_payer_notes": "100.00% of Medicare Rates" } ] } ] }, { "description": "OTHER BACK & NECK DISORDERS, FRACTURES & INJURIES - SOI : 4", "code_information": [ { "code": "3474", "type": "APR-DRG" } ], "standard_charges": [ { "setting": "inpatient", "minimum": 23883.13, "maximum": 26271.45, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Better Health - Medi Medi", "methodology": "case rate", "standard_charge_dollar": 26271.45, "additional_payer_notes": "110% of State Medicaid Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Better Health Medicaid", "methodology": "case rate", "standard_charge_dollar": 26271.45, "additional_payer_notes": "110% of State Medicaid Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "case rate", "standard_charge_dollar": 23883.13, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "UBH", "plan_name": "UBH Medicaid", "methodology": "case rate", "standard_charge_dollar": 23883.13, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicaid (02/01/2023 to 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 24360.8, "additional_payer_notes": "102% of State Medicaid Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicaid", "methodology": "case rate", "standard_charge_dollar": 23883.13, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup Medicaid", "methodology": "case rate", "standard_charge_dollar": 23883.13, "additional_payer_notes": "100% of State Medicaid Rates" } ] } ] }, { "description": "MALIGNANCY OF HEPATOBILIARY SYSTEM & PANCREAS - SOI : 1", "code_information": [ { "code": "2811", "type": "APR-DRG" } ], "standard_charges": [ { "setting": "inpatient", "minimum": 7623.33, "maximum": 8385.66, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Better Health - Medi Medi", "methodology": "case rate", "standard_charge_dollar": 8385.66, "additional_payer_notes": "110% of State Medicaid Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Better Health Medicaid", "methodology": "case rate", "standard_charge_dollar": 8385.66, "additional_payer_notes": "110% of State Medicaid Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "case rate", "standard_charge_dollar": 7623.33, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "UBH", "plan_name": "UBH Medicaid", "methodology": "case rate", "standard_charge_dollar": 7623.33, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicaid (02/01/2023 to 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 7775.8, "additional_payer_notes": "102% of State Medicaid Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicaid", "methodology": "case rate", "standard_charge_dollar": 7623.33, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup Medicaid", "methodology": "case rate", "standard_charge_dollar": 7623.33, "additional_payer_notes": "100% of State Medicaid Rates" } ] } ] }, { "description": "MAJOR ESOPHAGEAL DISORDERS WITH MCC", "code_information": [ { "code": "368", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 19953.0, "minimum": 12138.99, "maximum": 37738.872, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "case rate", "standard_charge_dollar": 36115.76, "additional_payer_notes": "181.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medical Rental Network", "methodology": "case rate", "standard_charge_dollar": 36115.76, "additional_payer_notes": "181.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "case rate", "standard_charge_dollar": 16328.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "ALLY-ALIGN (FKA SPARTAN PLAN NJ, INC.)", "plan_name": "ALLY-ALIGN (FKA SPARTAN PLAN NJ, INC.)", "methodology": "case rate", "standard_charge_dollar": 20951.13, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Americhoice (UHC)", "plan_name": "UHC Medicare", "methodology": "case rate", "standard_charge_dollar": 16328.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Amerihealth", "plan_name": "Amerihealth Medicare", "methodology": "case rate", "standard_charge_dollar": 16328.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Commercial", "methodology": "case rate", "standard_charge_dollar": 23289.5 }, { "payer_name": "Clover Health", "plan_name": "Clover Medicare", "methodology": "case rate", "standard_charge_dollar": 16328.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Coventry", "plan_name": "Coventry Auto", "methodology": "case rate", "standard_charge_dollar": 33920.88, "additional_payer_notes": "170.00% of Medicare Rates" }, { "payer_name": "Coventry", "plan_name": "Coventry Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 33920.88, "additional_payer_notes": "170.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "case rate", "standard_charge_dollar": 25939.5, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Fairprice Healthcare Holdings", "plan_name": "Fairprice Healthcare Holdings", "methodology": "case rate", "standard_charge_dollar": 31925.54, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon Medicare", "methodology": "case rate", "standard_charge_dollar": 16328.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon NJ Health Medicaid", "methodology": "case rate", "standard_charge_dollar": 12138.99 }, { "payer_name": "Humana", "plan_name": "Humana Military Tricare", "methodology": "case rate", "standard_charge_dollar": 15962.77, "additional_payer_notes": "80.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 19953.46, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 13388.9 }, { "payer_name": "UBH", "plan_name": "UBH Medicare", "methodology": "case rate", "standard_charge_dollar": 16328.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC All Payer (02-01-2023 to 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 26833.07 }, { "payer_name": "UHC", "plan_name": "UHC Oxford (02-01-2023 to 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 23385.01 }, { "payer_name": "UHC - Adhoc", "plan_name": "UHC - Adhoc All Payer", "methodology": "case rate", "standard_charge_dollar": 28483.87 }, { "payer_name": "UHC - Adhoc", "plan_name": "UHC - Adhoc Oxford", "methodology": "case rate", "standard_charge_dollar": 24098.18 }, { "payer_name": "Wellcare", "plan_name": "Wellcare Insurance Exchange", "methodology": "case rate", "standard_charge_dollar": 26937.17, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "case rate", "standard_charge_dollar": 16328.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup Medicare", "methodology": "case rate", "standard_charge_dollar": 16328.8, "additional_payer_notes": "100.00% of Medicare Rates" } ] } ] }, { "description": "DORSAL & LUMBAR FUSION PROC EXCEPT FOR CURVATURE OF BACK - SOI : 2", "code_information": [ { "code": "3042", "type": "APR-DRG" } ], "standard_charges": [ { "setting": "inpatient", "minimum": 41434.57, "maximum": 45578.03, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Better Health - Medi Medi", "methodology": "case rate", "standard_charge_dollar": 45578.03, "additional_payer_notes": "110% of State Medicaid Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Better Health Medicaid", "methodology": "case rate", "standard_charge_dollar": 45578.03, "additional_payer_notes": "110% of State Medicaid Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "case rate", "standard_charge_dollar": 41434.57, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "UBH", "plan_name": "UBH Medicaid", "methodology": "case rate", "standard_charge_dollar": 41434.57, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicaid (02/01/2023 to 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 42263.27, "additional_payer_notes": "102% of State Medicaid Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicaid", "methodology": "case rate", "standard_charge_dollar": 41434.57, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup Medicaid", "methodology": "case rate", "standard_charge_dollar": 41434.57, "additional_payer_notes": "100% of State Medicaid Rates" } ] } ] }, { "description": "Hc Non-Invasive Lowr Extrm Art Strss/Rest Complt Bilat", "code_information": [ { "code": "93924", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 298.0, "discounted_cash": 255.0, "minimum": 56.8882, "maximum": 298.0, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 298.0, "additional_payer_notes": "212.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medical Rental Network", "methodology": "fee schedule", "standard_charge_dollar": 298.0, "additional_payer_notes": "212.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 255.26, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "ALLY-ALIGN (FKA SPARTAN PLAN NJ, INC.)", "plan_name": "ALLY-ALIGN (FKA SPARTAN PLAN NJ, INC.)", "methodology": "fee schedule", "standard_charge_dollar": 268.02, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Americhoice (UHC)", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 255.26, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Amerihealth", "plan_name": "Amerihealth Medicare", "methodology": "fee schedule", "standard_charge_dollar": 255.26, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 298.0, "additional_payer_notes": "146.95% of Medicare Rates" }, { "payer_name": "Clover Health", "plan_name": "Clover Medicare", "methodology": "fee schedule", "standard_charge_dollar": 255.26, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Coventry", "plan_name": "Coventry Auto", "methodology": "fee schedule", "standard_charge_dollar": 298.0, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Coventry", "plan_name": "Coventry Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 298.0, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "fee schedule", "standard_charge_dollar": 298.0, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Fairprice Healthcare Holdings", "plan_name": "Fairprice Healthcare Holdings", "methodology": "fee schedule", "standard_charge_dollar": 298.0, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ HMO POS", "methodology": "fee schedule", "standard_charge_dollar": 298.0, "additional_payer_notes": "177.30% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ Indemnity", "methodology": "fee schedule", "standard_charge_dollar": 298.0, "additional_payer_notes": "177.30% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ PPO", "methodology": "fee schedule", "standard_charge_dollar": 298.0, "additional_payer_notes": "177.30% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon Medicare", "methodology": "fee schedule", "standard_charge_dollar": 255.26, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Military Tricare", "methodology": "fee schedule", "standard_charge_dollar": 204.21, "additional_payer_notes": "80.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 255.26, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 255.26, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC All Payer (02-01-2023 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 298.0 }, { "payer_name": "UHC", "plan_name": "UHC Oxford (02-01-2023 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 298.0 }, { "payer_name": "UHC - Adhoc", "plan_name": "UHC - Adhoc All Payer", "methodology": "fee schedule", "standard_charge_dollar": 298.0 }, { "payer_name": "UHC - Adhoc", "plan_name": "UHC - Adhoc Oxford", "methodology": "fee schedule", "standard_charge_dollar": 298.0 }, { "payer_name": "Wellcare", "plan_name": "Wellcare Insurance Exchange", "methodology": "fee schedule", "standard_charge_dollar": 298.0, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 255.26, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup Medicare", "methodology": "fee schedule", "standard_charge_dollar": 255.26, "additional_payer_notes": "100.00% of Medicare Rates" } ] } ] }, { "description": "INFLAMMATORY BOWEL DISEASE - SOI : 4", "code_information": [ { "code": "2454", "type": "APR-DRG" } ], "standard_charges": [ { "setting": "inpatient", "minimum": 22012.73, "maximum": 24214.0, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Better Health - Medi Medi", "methodology": "case rate", "standard_charge_dollar": 24214.0, "additional_payer_notes": "110% of State Medicaid Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Better Health Medicaid", "methodology": "case rate", "standard_charge_dollar": 24214.0, "additional_payer_notes": "110% of State Medicaid Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "case rate", "standard_charge_dollar": 22012.73, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "UBH", "plan_name": "UBH Medicaid", "methodology": "case rate", "standard_charge_dollar": 22012.73, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicaid (02/01/2023 to 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 22452.98, "additional_payer_notes": "102% of State Medicaid Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicaid", "methodology": "case rate", "standard_charge_dollar": 22012.73, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup Medicaid", "methodology": "case rate", "standard_charge_dollar": 22012.73, "additional_payer_notes": "100% of State Medicaid Rates" } ] } ] }, { "description": "Hc Cyto/Molecular Report", "code_information": [ { "code": "88291", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 204.0, "minimum": 20.79, "maximum": 173.4, "payers_information": [ { "payer_name": "Horizon", "plan_name": "Horizon NJ Health Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 26.68 }, { "payer_name": "UHC", "plan_name": "UHC All Payer (02-01-2023 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 20.79 }, { "payer_name": "UHC", "plan_name": "UHC Medicaid (02/01/2023 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 26.68 }, { "payer_name": "UHC", "plan_name": "UHC Oxford (02-01-2023 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 20.79 }, { "payer_name": "UHC - Adhoc", "plan_name": "UHC - Adhoc All Payer", "methodology": "fee schedule", "standard_charge_dollar": 34.65 }, { "payer_name": "UHC - Adhoc", "plan_name": "UHC - Adhoc Oxford", "methodology": "fee schedule", "standard_charge_dollar": 34.65 } ] } ] }, { "description": "OTHER CIRCULATORY SYSTEM PROCEDURES - SOI : 2", "code_information": [ { "code": "1802", "type": "APR-DRG" } ], "standard_charges": [ { "setting": "inpatient", "minimum": 18290.03, "maximum": 20119.04, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Better Health - Medi Medi", "methodology": "case rate", "standard_charge_dollar": 20119.04, "additional_payer_notes": "110% of State Medicaid Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Better Health Medicaid", "methodology": "case rate", "standard_charge_dollar": 20119.04, "additional_payer_notes": "110% of State Medicaid Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "case rate", "standard_charge_dollar": 18290.03, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "UBH", "plan_name": "UBH Medicaid", "methodology": "case rate", "standard_charge_dollar": 18290.03, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicaid (02/01/2023 to 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 18655.83, "additional_payer_notes": "102% of State Medicaid Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicaid", "methodology": "case rate", "standard_charge_dollar": 18290.03, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup Medicaid", "methodology": "case rate", "standard_charge_dollar": 18290.03, "additional_payer_notes": "100% of State Medicaid Rates" } ] } ] }, { "description": "Hc Cyp2C19 Gene Analysis Common Variants", "code_information": [ { "code": "81225", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 436.5, "discounted_cash": 291.0, "minimum": 83.3278, "maximum": 436.5, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 436.5, "additional_payer_notes": "212.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medical Rental Network", "methodology": "fee schedule", "standard_charge_dollar": 436.5, "additional_payer_notes": "212.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 291.36, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "ALLY-ALIGN (FKA SPARTAN PLAN NJ, INC.)", "plan_name": "ALLY-ALIGN (FKA SPARTAN PLAN NJ, INC.)", "methodology": "fee schedule", "standard_charge_dollar": 305.93, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Americhoice (UHC)", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 291.36, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Amerihealth", "plan_name": "Amerihealth Medicare", "methodology": "fee schedule", "standard_charge_dollar": 291.36, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 422.47, "additional_payer_notes": "A Indicator - 155.00% of Medicare Rates" }, { "payer_name": "Clover Health", "plan_name": "Clover Medicare", "methodology": "fee schedule", "standard_charge_dollar": 291.36, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Coventry", "plan_name": "Coventry Auto", "methodology": "fee schedule", "standard_charge_dollar": 436.5, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Coventry", "plan_name": "Coventry Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 436.5, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "fee schedule", "standard_charge_dollar": 407.9, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Fairprice Healthcare Holdings", "plan_name": "Fairprice Healthcare Holdings", "methodology": "fee schedule", "standard_charge_dollar": 349.63, "additional_payer_notes": "Laboratory - 120.00% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ HMO POS", "methodology": "fee schedule", "standard_charge_dollar": 308.17, "additional_payer_notes": "177.30% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ Indemnity", "methodology": "fee schedule", "standard_charge_dollar": 308.17, "additional_payer_notes": "177.30% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ PPO", "methodology": "fee schedule", "standard_charge_dollar": 308.17, "additional_payer_notes": "177.30% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon Medicare", "methodology": "fee schedule", "standard_charge_dollar": 291.36, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Military Tricare", "methodology": "fee schedule", "standard_charge_dollar": 233.09, "additional_payer_notes": "80.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 291.36, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 291.36, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC All Payer (02-01-2023 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 174.82 }, { "payer_name": "UHC", "plan_name": "UHC Medicaid (02/01/2023 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 233.09 }, { "payer_name": "UHC", "plan_name": "UHC Oxford (02-01-2023 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 174.82 }, { "payer_name": "UHC - Adhoc", "plan_name": "UHC - Adhoc All Payer", "methodology": "fee schedule", "standard_charge_dollar": 291.36 }, { "payer_name": "UHC - Adhoc", "plan_name": "UHC - Adhoc Oxford", "methodology": "fee schedule", "standard_charge_dollar": 291.36 }, { "payer_name": "Wellcare", "plan_name": "Wellcare Insurance Exchange", "methodology": "fee schedule", "standard_charge_dollar": 393.34, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 291.36, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup Medicare", "methodology": "fee schedule", "standard_charge_dollar": 291.36, "additional_payer_notes": "100.00% of Medicare Rates" } ] } ] }, { "description": "Hc Alpha-1-Antitrypsin, Total", "code_information": [ { "code": "82103", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 67.0, "discounted_cash": 13.0, "minimum": 8.06, "maximum": 56.95, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 28.49, "additional_payer_notes": "212.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medical Rental Network", "methodology": "fee schedule", "standard_charge_dollar": 28.49, "additional_payer_notes": "212.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 13.44, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "ALLY-ALIGN (FKA SPARTAN PLAN NJ, INC.)", "plan_name": "ALLY-ALIGN (FKA SPARTAN PLAN NJ, INC.)", "methodology": "fee schedule", "standard_charge_dollar": 14.11, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Americhoice (UHC)", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 13.44, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Amerihealth", "plan_name": "Amerihealth Medicare", "methodology": "fee schedule", "standard_charge_dollar": 13.44, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 19.49, "additional_payer_notes": "Laboratory - 145.00% of Medicare Rates" }, { "payer_name": "Clover Health", "plan_name": "Clover Medicare", "methodology": "fee schedule", "standard_charge_dollar": 13.44, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Coventry", "plan_name": "Coventry Auto", "methodology": "fee schedule", "standard_charge_dollar": 26.88, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Coventry", "plan_name": "Coventry Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 26.88, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "fee schedule", "standard_charge_dollar": 18.82, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Fairprice Healthcare Holdings", "plan_name": "Fairprice Healthcare Holdings", "methodology": "fee schedule", "standard_charge_dollar": 16.13, "additional_payer_notes": "Laboratory - 120.00% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ HMO POS", "methodology": "fee schedule", "standard_charge_dollar": 47.3, "additional_payer_notes": "177.30% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ Indemnity", "methodology": "fee schedule", "standard_charge_dollar": 47.3, "additional_payer_notes": "177.30% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ PPO", "methodology": "fee schedule", "standard_charge_dollar": 47.3, "additional_payer_notes": "177.30% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon Medicare", "methodology": "fee schedule", "standard_charge_dollar": 13.44, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Military Tricare", "methodology": "fee schedule", "standard_charge_dollar": 10.75, "additional_payer_notes": "80.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 13.44, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 13.44, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC All Payer (02-01-2023 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 8.06 }, { "payer_name": "UHC", "plan_name": "UHC Medicaid (02/01/2023 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 10.75 }, { "payer_name": "UHC", "plan_name": "UHC Oxford (02-01-2023 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 8.06 }, { "payer_name": "UHC - Adhoc", "plan_name": "UHC - Adhoc All Payer", "methodology": "fee schedule", "standard_charge_dollar": 13.44 }, { "payer_name": "UHC - Adhoc", "plan_name": "UHC - Adhoc Oxford", "methodology": "fee schedule", "standard_charge_dollar": 13.44 }, { "payer_name": "Wellcare", "plan_name": "Wellcare Insurance Exchange", "methodology": "fee schedule", "standard_charge_dollar": 18.14, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 13.44, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup Medicare", "methodology": "fee schedule", "standard_charge_dollar": 13.44, "additional_payer_notes": "100.00% of Medicare Rates" } ] } ] }, { "description": "Hc Hemoglobin", "code_information": [ { "code": "85018", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 39.0, "discounted_cash": 2.0, "minimum": 1.42, "maximum": 33.15, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 5.02, "additional_payer_notes": "212.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medical Rental Network", "methodology": "fee schedule", "standard_charge_dollar": 5.02, "additional_payer_notes": "212.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2.37, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "ALLY-ALIGN (FKA SPARTAN PLAN NJ, INC.)", "plan_name": "ALLY-ALIGN (FKA SPARTAN PLAN NJ, INC.)", "methodology": "fee schedule", "standard_charge_dollar": 2.49, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Americhoice (UHC)", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2.37, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Amerihealth", "plan_name": "Amerihealth Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2.37, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 3.44, "additional_payer_notes": "Laboratory - 145.00% of Medicare Rates" }, { "payer_name": "Clover Health", "plan_name": "Clover Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2.37, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Coventry", "plan_name": "Coventry Auto", "methodology": "fee schedule", "standard_charge_dollar": 4.74, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Coventry", "plan_name": "Coventry Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 4.74, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "fee schedule", "standard_charge_dollar": 3.32, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Fairprice Healthcare Holdings", "plan_name": "Fairprice Healthcare Holdings", "methodology": "fee schedule", "standard_charge_dollar": 2.84, "additional_payer_notes": "Laboratory - 120.00% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ HMO POS", "methodology": "fee schedule", "standard_charge_dollar": 27.53, "additional_payer_notes": "177.30% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ Indemnity", "methodology": "fee schedule", "standard_charge_dollar": 27.53, "additional_payer_notes": "177.30% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ PPO", "methodology": "fee schedule", "standard_charge_dollar": 27.53, "additional_payer_notes": "177.30% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2.37, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Military Tricare", "methodology": "fee schedule", "standard_charge_dollar": 1.9, "additional_payer_notes": "80.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2.37, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 2.37, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC All Payer (02-01-2023 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 1.42 }, { "payer_name": "UHC", "plan_name": "UHC Medicaid (02/01/2023 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 1.9 }, { "payer_name": "UHC", "plan_name": "UHC Oxford (02-01-2023 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 1.42 }, { "payer_name": "UHC - Adhoc", "plan_name": "UHC - Adhoc All Payer", "methodology": "fee schedule", "standard_charge_dollar": 2.37 }, { "payer_name": "UHC - Adhoc", "plan_name": "UHC - Adhoc Oxford", "methodology": "fee schedule", "standard_charge_dollar": 2.37 }, { "payer_name": "Wellcare", "plan_name": "Wellcare Insurance Exchange", "methodology": "fee schedule", "standard_charge_dollar": 3.2, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2.37, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup Medicaid", "methodology": "percent of total billed charges", "standard_charge_percentage": 19.09, "median_amount": 2.37, "10th_percentile": 2.37, "90th_percentile": 7.27, "count": "1 through 10" }, { "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2.37, "additional_payer_notes": "100.00% of Medicare Rates" } ] } ] }, { "description": "Hc B Cells, Total Count", "code_information": [ { "code": "86355", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 128.0, "discounted_cash": 37.0, "minimum": 22.64, "maximum": 108.8, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 79.99, "additional_payer_notes": "212.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medical Rental Network", "methodology": "fee schedule", "standard_charge_dollar": 79.99, "additional_payer_notes": "212.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 37.73, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "ALLY-ALIGN (FKA SPARTAN PLAN NJ, INC.)", "plan_name": "ALLY-ALIGN (FKA SPARTAN PLAN NJ, INC.)", "methodology": "fee schedule", "standard_charge_dollar": 39.62, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Americhoice (UHC)", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 37.73, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Amerihealth", "plan_name": "Amerihealth Medicare", "methodology": "fee schedule", "standard_charge_dollar": 37.73, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 54.71, "additional_payer_notes": "Laboratory - 145.00% of Medicare Rates" }, { "payer_name": "Clover Health", "plan_name": "Clover Medicare", "methodology": "fee schedule", "standard_charge_dollar": 37.73, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Coventry", "plan_name": "Coventry Auto", "methodology": "fee schedule", "standard_charge_dollar": 75.46, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Coventry", "plan_name": "Coventry Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 75.46, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "fee schedule", "standard_charge_dollar": 52.82, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Fairprice Healthcare Holdings", "plan_name": "Fairprice Healthcare Holdings", "methodology": "fee schedule", "standard_charge_dollar": 45.28, "additional_payer_notes": "Laboratory - 120.00% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ HMO POS", "methodology": "fee schedule", "standard_charge_dollar": 90.37, "additional_payer_notes": "177.30% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ Indemnity", "methodology": "fee schedule", "standard_charge_dollar": 90.37, "additional_payer_notes": "177.30% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ PPO", "methodology": "fee schedule", "standard_charge_dollar": 90.37, "additional_payer_notes": "177.30% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon Medicare", "methodology": "fee schedule", "standard_charge_dollar": 37.73, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Military Tricare", "methodology": "fee schedule", "standard_charge_dollar": 30.18, "additional_payer_notes": "80.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 37.73, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 37.73, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC All Payer (02-01-2023 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 22.64 }, { "payer_name": "UHC", "plan_name": "UHC Medicaid (02/01/2023 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 30.18 }, { "payer_name": "UHC", "plan_name": "UHC Oxford (02-01-2023 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 22.64 }, { "payer_name": "UHC - Adhoc", "plan_name": "UHC - Adhoc All Payer", "methodology": "fee schedule", "standard_charge_dollar": 37.73 }, { "payer_name": "UHC - Adhoc", "plan_name": "UHC - Adhoc Oxford", "methodology": "fee schedule", "standard_charge_dollar": 37.73 }, { "payer_name": "Wellcare", "plan_name": "Wellcare Insurance Exchange", "methodology": "fee schedule", "standard_charge_dollar": 50.94, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 37.73, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup Medicare", "methodology": "fee schedule", "standard_charge_dollar": 37.73, "additional_payer_notes": "100.00% of Medicare Rates" } ] } ] }, { "description": "Derma-fat-fascia graft", "code_information": [ { "code": "15770", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 38475.0, "discounted_cash": 4189.0, "minimum": 1715.0, "maximum": 30780.0, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 8881.53, "additional_payer_notes": "212.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medical Rental Network", "methodology": "fee schedule", "standard_charge_dollar": 8881.53, "additional_payer_notes": "212.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 4189.4, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "ALLY-ALIGN (FKA SPARTAN PLAN NJ, INC.)", "plan_name": "ALLY-ALIGN (FKA SPARTAN PLAN NJ, INC.)", "methodology": "fee schedule", "standard_charge_dollar": 4398.87, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Americhoice (UHC)", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 4189.4, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Amerihealth", "plan_name": "Amerihealth Medicare", "methodology": "fee schedule", "standard_charge_dollar": 4189.4, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 6156.32, "additional_payer_notes": "146.95% of Medicare Rates" }, { "payer_name": "Clover Health", "plan_name": "Clover Medicare", "methodology": "fee schedule", "standard_charge_dollar": 4189.4, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Coventry", "plan_name": "Coventry Auto", "methodology": "fee schedule", "standard_charge_dollar": 8378.8, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Coventry", "plan_name": "Coventry Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 8378.8, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "fee schedule", "standard_charge_dollar": 5865.16, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Fairprice Healthcare Holdings", "plan_name": "Fairprice Healthcare Holdings", "methodology": "fee schedule", "standard_charge_dollar": 6703.04, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ HMO POS", "methodology": "fee schedule", "standard_charge_dollar": 7427.81, "additional_payer_notes": "177.30% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ Indemnity", "methodology": "fee schedule", "standard_charge_dollar": 7427.81, "additional_payer_notes": "177.30% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ PPO", "methodology": "fee schedule", "standard_charge_dollar": 7427.81, "additional_payer_notes": "177.30% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon Medicare", "methodology": "fee schedule", "standard_charge_dollar": 4189.4, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Military Tricare", "methodology": "fee schedule", "standard_charge_dollar": 3351.52, "additional_payer_notes": "80.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 4189.4, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 4189.4, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC All Payer (02-01-2023 to 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 5378.0 }, { "payer_name": "UHC", "plan_name": "UHC Oxford (02-01-2023 to 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 5169.0 }, { "payer_name": "UHC - Adhoc", "plan_name": "UHC - Adhoc All Payer", "methodology": "case rate", "standard_charge_dollar": 5709.0 }, { "payer_name": "UHC - Adhoc", "plan_name": "UHC - Adhoc Oxford", "methodology": "case rate", "standard_charge_dollar": 5327.0 }, { "payer_name": "Wellcare", "plan_name": "Wellcare Insurance Exchange", "methodology": "fee schedule", "standard_charge_dollar": 5655.69, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 4189.4, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellchoice", "plan_name": "WELLCHOICE HMO of NJ (Empire) Commercial (HMO / HMO POS, PPO)", "methodology": "case rate", "standard_charge_dollar": 1715.0 }, { "payer_name": "Wellchoice", "plan_name": "WELLCHOICE HMO of NJ (Empire) Commercial (Indemnity)", "methodology": "case rate", "standard_charge_dollar": 1978.0 }, { "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup Medicare", "methodology": "fee schedule", "standard_charge_dollar": 4189.4, "additional_payer_notes": "100.00% of Medicare Rates" } ] } ] }, { "description": "CESAREAN SECTION WITHOUT STERILIZATION WITHOUT CCMCC", "code_information": [ { "code": "788", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 12637.0, "minimum": 4406.63, "maximum": 22873.0786, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "case rate", "standard_charge_dollar": 22873.08, "additional_payer_notes": "181.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medical Rental Network", "methodology": "case rate", "standard_charge_dollar": 22873.08, "additional_payer_notes": "181.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "case rate", "standard_charge_dollar": 10453.9, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "ALLY-ALIGN (FKA SPARTAN PLAN NJ, INC.)", "plan_name": "ALLY-ALIGN (FKA SPARTAN PLAN NJ, INC.)", "methodology": "case rate", "standard_charge_dollar": 13268.91, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Americhoice (UHC)", "plan_name": "UHC Medicare", "methodology": "case rate", "standard_charge_dollar": 10453.9, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Amerihealth", "plan_name": "Amerihealth Medicare", "methodology": "case rate", "standard_charge_dollar": 10453.9, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Commercial", "methodology": "case rate", "standard_charge_dollar": 14027.24 }, { "payer_name": "Clover Health", "plan_name": "Clover Medicare", "methodology": "case rate", "standard_charge_dollar": 10453.9, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Coventry", "plan_name": "Coventry Auto", "methodology": "case rate", "standard_charge_dollar": 21483.0, "additional_payer_notes": "170.00% of Medicare Rates" }, { "payer_name": "Coventry", "plan_name": "Coventry Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 21483.0, "additional_payer_notes": "170.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "case rate", "standard_charge_dollar": 16428.18, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Fairprice Healthcare Holdings", "plan_name": "Fairprice Healthcare Holdings", "methodology": "case rate", "standard_charge_dollar": 20219.3, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon Casualty Services Personal Injury Protection - PIP", "methodology": "case rate", "standard_charge_dollar": 9009.0 }, { "payer_name": "Horizon", "plan_name": "Horizon Casualty Services Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 9923.0 }, { "payer_name": "Horizon", "plan_name": "Horizon Medicare", "methodology": "case rate", "standard_charge_dollar": 10453.9, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon NJ Health Medicaid", "methodology": "case rate", "standard_charge_dollar": 4406.63 }, { "payer_name": "Humana", "plan_name": "Humana Military Tricare", "methodology": "case rate", "standard_charge_dollar": 10109.65, "additional_payer_notes": "80.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 12637.06, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 13021.9 }, { "payer_name": "UBH", "plan_name": "UBH Medicare", "methodology": "case rate", "standard_charge_dollar": 10453.9, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC All Payer (02-01-2023 to 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 8981.0 }, { "payer_name": "UHC", "plan_name": "UHC Oxford (02-01-2023 to 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 7828.0 }, { "payer_name": "UHC - Adhoc", "plan_name": "UHC - Adhoc All Payer", "methodology": "case rate", "standard_charge_dollar": 9533.0 }, { "payer_name": "UHC - Adhoc", "plan_name": "UHC - Adhoc Oxford", "methodology": "case rate", "standard_charge_dollar": 8067.0 }, { "payer_name": "Wellcare", "plan_name": "Wellcare Insurance Exchange", "methodology": "case rate", "standard_charge_dollar": 17060.03, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "case rate", "standard_charge_dollar": 10453.9, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellchoice", "plan_name": "WELLCHOICE HMO of NJ (Empire) Commercial (HMO / HMO POS, PPO)", "methodology": "case rate", "standard_charge_dollar": 7388.0 }, { "payer_name": "Wellchoice", "plan_name": "WELLCHOICE HMO of NJ (Empire) Commercial (Indemnity)", "methodology": "case rate", "standard_charge_dollar": 8058.0 }, { "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup Medicare", "methodology": "case rate", "standard_charge_dollar": 10453.9, "additional_payer_notes": "100.00% of Medicare Rates" } ] } ] }, { "description": "NON-EXTENSIVE O.R. PROCEDURE UNRELATED TO PRINCIPAL DIAGNOSIS- SOI : 2", "code_information": [ { "code": "9522", "type": "APR-DRG" } ], "standard_charges": [ { "setting": "inpatient", "minimum": 15440.03, "maximum": 16984.03, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Better Health - Medi Medi", "methodology": "case rate", "standard_charge_dollar": 16984.03, "additional_payer_notes": "110% of State Medicaid Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Better Health Medicaid", "methodology": "case rate", "standard_charge_dollar": 16984.03, "additional_payer_notes": "110% of State Medicaid Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "case rate", "standard_charge_dollar": 15440.03, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "UBH", "plan_name": "UBH Medicaid", "methodology": "case rate", "standard_charge_dollar": 15440.03, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicaid (02/01/2023 to 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 15748.83, "additional_payer_notes": "102% of State Medicaid Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicaid", "methodology": "case rate", "standard_charge_dollar": 15440.03, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup Medicaid", "methodology": "case rate", "standard_charge_dollar": 15440.03, "additional_payer_notes": "100% of State Medicaid Rates" } ] } ] }, { "description": "Hc Cryptosporidum Ag, Immunofluor", "code_information": [ { "code": "87272", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 48.0, "discounted_cash": 11.0, "minimum": 7.19, "maximum": 40.8, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 25.4, "additional_payer_notes": "212.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medical Rental Network", "methodology": "fee schedule", "standard_charge_dollar": 25.4, "additional_payer_notes": "212.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 11.98, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "ALLY-ALIGN (FKA SPARTAN PLAN NJ, INC.)", "plan_name": "ALLY-ALIGN (FKA SPARTAN PLAN NJ, INC.)", "methodology": "fee schedule", "standard_charge_dollar": 12.58, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Americhoice (UHC)", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 11.98, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Amerihealth", "plan_name": "Amerihealth Medicare", "methodology": "fee schedule", "standard_charge_dollar": 11.98, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 17.37, "additional_payer_notes": "Laboratory - 145.00% of Medicare Rates" }, { "payer_name": "Clover Health", "plan_name": "Clover Medicare", "methodology": "fee schedule", "standard_charge_dollar": 11.98, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Coventry", "plan_name": "Coventry Auto", "methodology": "fee schedule", "standard_charge_dollar": 23.96, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Coventry", "plan_name": "Coventry Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 23.96, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "fee schedule", "standard_charge_dollar": 16.77, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Fairprice Healthcare Holdings", "plan_name": "Fairprice Healthcare Holdings", "methodology": "fee schedule", "standard_charge_dollar": 14.38, "additional_payer_notes": "Laboratory - 120.00% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ HMO POS", "methodology": "fee schedule", "standard_charge_dollar": 33.89, "additional_payer_notes": "177.30% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ Indemnity", "methodology": "fee schedule", "standard_charge_dollar": 33.89, "additional_payer_notes": "177.30% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ PPO", "methodology": "fee schedule", "standard_charge_dollar": 33.89, "additional_payer_notes": "177.30% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon Medicare", "methodology": "fee schedule", "standard_charge_dollar": 11.98, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Military Tricare", "methodology": "fee schedule", "standard_charge_dollar": 9.58, "additional_payer_notes": "80.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 11.98, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 11.98, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC All Payer (02-01-2023 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 7.19 }, { "payer_name": "UHC", "plan_name": "UHC Medicaid (02/01/2023 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 9.58 }, { "payer_name": "UHC", "plan_name": "UHC Oxford (02-01-2023 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 7.19 }, { "payer_name": "UHC - Adhoc", "plan_name": "UHC - Adhoc All Payer", "methodology": "fee schedule", "standard_charge_dollar": 11.98 }, { "payer_name": "UHC - Adhoc", "plan_name": "UHC - Adhoc Oxford", "methodology": "fee schedule", "standard_charge_dollar": 11.98 }, { "payer_name": "Wellcare", "plan_name": "Wellcare Insurance Exchange", "methodology": "fee schedule", "standard_charge_dollar": 16.17, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 11.98, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup Medicare", "methodology": "fee schedule", "standard_charge_dollar": 11.98, "additional_payer_notes": "100.00% of Medicare Rates" } ] } ] }, { "description": "Hc Blood Clot Factor V Test", "code_information": [ { "code": "85220", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 87.0, "discounted_cash": 17.0, "minimum": 10.59, "maximum": 73.95, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 37.42, "additional_payer_notes": "212.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medical Rental Network", "methodology": "fee schedule", "standard_charge_dollar": 37.42, "additional_payer_notes": "212.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 17.65, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "ALLY-ALIGN (FKA SPARTAN PLAN NJ, INC.)", "plan_name": "ALLY-ALIGN (FKA SPARTAN PLAN NJ, INC.)", "methodology": "fee schedule", "standard_charge_dollar": 18.53, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Americhoice (UHC)", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 17.65, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Amerihealth", "plan_name": "Amerihealth Medicare", "methodology": "fee schedule", "standard_charge_dollar": 17.65, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 25.59, "additional_payer_notes": "Laboratory - 145.00% of Medicare Rates" }, { "payer_name": "Clover Health", "plan_name": "Clover Medicare", "methodology": "fee schedule", "standard_charge_dollar": 17.65, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Coventry", "plan_name": "Coventry Auto", "methodology": "fee schedule", "standard_charge_dollar": 35.3, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Coventry", "plan_name": "Coventry Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 35.3, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "fee schedule", "standard_charge_dollar": 24.71, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Fairprice Healthcare Holdings", "plan_name": "Fairprice Healthcare Holdings", "methodology": "fee schedule", "standard_charge_dollar": 21.18, "additional_payer_notes": "Laboratory - 120.00% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ HMO POS", "methodology": "fee schedule", "standard_charge_dollar": 61.42, "additional_payer_notes": "177.30% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ Indemnity", "methodology": "fee schedule", "standard_charge_dollar": 61.42, "additional_payer_notes": "177.30% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ PPO", "methodology": "fee schedule", "standard_charge_dollar": 61.42, "additional_payer_notes": "177.30% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon Medicare", "methodology": "fee schedule", "standard_charge_dollar": 17.65, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Military Tricare", "methodology": "fee schedule", "standard_charge_dollar": 14.12, "additional_payer_notes": "80.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 17.65, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 17.65, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC All Payer (02-01-2023 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 10.59 }, { "payer_name": "UHC", "plan_name": "UHC Medicaid (02/01/2023 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 14.12 }, { "payer_name": "UHC", "plan_name": "UHC Oxford (02-01-2023 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 10.59 }, { "payer_name": "UHC - Adhoc", "plan_name": "UHC - Adhoc All Payer", "methodology": "fee schedule", "standard_charge_dollar": 17.65 }, { "payer_name": "UHC - Adhoc", "plan_name": "UHC - Adhoc Oxford", "methodology": "fee schedule", "standard_charge_dollar": 17.65 }, { "payer_name": "Wellcare", "plan_name": "Wellcare Insurance Exchange", "methodology": "fee schedule", "standard_charge_dollar": 23.83, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 17.65, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup Medicare", "methodology": "fee schedule", "standard_charge_dollar": 17.65, "additional_payer_notes": "100.00% of Medicare Rates" } ] } ] }, { "description": "VIRAL ILLNESS WITHOUT MCC", "code_information": [ { "code": "866", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 11606.0, "minimum": 5122.85, "maximum": 21007.2763, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "case rate", "standard_charge_dollar": 21007.28, "additional_payer_notes": "181.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medical Rental Network", "methodology": "case rate", "standard_charge_dollar": 21007.28, "additional_payer_notes": "181.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "case rate", "standard_charge_dollar": 9626.2, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "ALLY-ALIGN (FKA SPARTAN PLAN NJ, INC.)", "plan_name": "ALLY-ALIGN (FKA SPARTAN PLAN NJ, INC.)", "methodology": "case rate", "standard_charge_dollar": 12186.54, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Americhoice (UHC)", "plan_name": "UHC Medicare", "methodology": "case rate", "standard_charge_dollar": 9626.2, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Amerihealth", "plan_name": "Amerihealth Medicare", "methodology": "case rate", "standard_charge_dollar": 9626.2, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Commercial", "methodology": "case rate", "standard_charge_dollar": 12722.25 }, { "payer_name": "Clover Health", "plan_name": "Clover Medicare", "methodology": "case rate", "standard_charge_dollar": 9626.2, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Coventry", "plan_name": "Coventry Auto", "methodology": "case rate", "standard_charge_dollar": 19730.59, "additional_payer_notes": "170.00% of Medicare Rates" }, { "payer_name": "Coventry", "plan_name": "Coventry Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 19730.59, "additional_payer_notes": "170.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "case rate", "standard_charge_dollar": 15088.1, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Fairprice Healthcare Holdings", "plan_name": "Fairprice Healthcare Holdings", "methodology": "case rate", "standard_charge_dollar": 18569.97, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon Medicare", "methodology": "case rate", "standard_charge_dollar": 9626.2, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon NJ Health Medicaid", "methodology": "case rate", "standard_charge_dollar": 5122.85 }, { "payer_name": "Humana", "plan_name": "Humana Military Tricare", "methodology": "case rate", "standard_charge_dollar": 9284.98, "additional_payer_notes": "80.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 11606.23, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 7689.94 }, { "payer_name": "UBH", "plan_name": "UBH Medicare", "methodology": "case rate", "standard_charge_dollar": 9626.2, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC All Payer (02-01-2023 to 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 14657.98 }, { "payer_name": "UHC", "plan_name": "UHC Oxford (02-01-2023 to 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 12774.42 }, { "payer_name": "UHC - Adhoc", "plan_name": "UHC - Adhoc All Payer", "methodology": "case rate", "standard_charge_dollar": 15559.75 }, { "payer_name": "UHC - Adhoc", "plan_name": "UHC - Adhoc Oxford", "methodology": "case rate", "standard_charge_dollar": 13164.0 }, { "payer_name": "Wellcare", "plan_name": "Wellcare Insurance Exchange", "methodology": "case rate", "standard_charge_dollar": 15668.41, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "case rate", "standard_charge_dollar": 9626.2, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup Medicare", "methodology": "case rate", "standard_charge_dollar": 9626.2, "additional_payer_notes": "100.00% of Medicare Rates" } ] } ] }, { "description": "Revision Of Calf Tendon", "code_information": [ { "code": "27687", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 19237.5, "discounted_cash": 3868.0, "minimum": 1715.0, "maximum": 15390.0, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 8200.52, "additional_payer_notes": "212.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medical Rental Network", "methodology": "fee schedule", "standard_charge_dollar": 8200.52, "additional_payer_notes": "212.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3868.17, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "ALLY-ALIGN (FKA SPARTAN PLAN NJ, INC.)", "plan_name": "ALLY-ALIGN (FKA SPARTAN PLAN NJ, INC.)", "methodology": "fee schedule", "standard_charge_dollar": 4061.58, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Americhoice (UHC)", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3868.17, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Amerihealth", "plan_name": "Amerihealth Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3868.17, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 5684.28, "additional_payer_notes": "146.95% of Medicare Rates" }, { "payer_name": "Clover Health", "plan_name": "Clover Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3868.17, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Coventry", "plan_name": "Coventry Auto", "methodology": "fee schedule", "standard_charge_dollar": 7736.34, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Coventry", "plan_name": "Coventry Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 7736.34, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "fee schedule", "standard_charge_dollar": 5415.44, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Fairprice Healthcare Holdings", "plan_name": "Fairprice Healthcare Holdings", "methodology": "fee schedule", "standard_charge_dollar": 6189.07, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ HMO POS", "methodology": "fee schedule", "standard_charge_dollar": 6858.27, "additional_payer_notes": "177.30% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ Indemnity", "methodology": "fee schedule", "standard_charge_dollar": 6858.27, "additional_payer_notes": "177.30% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ PPO", "methodology": "fee schedule", "standard_charge_dollar": 6858.27, "additional_payer_notes": "177.30% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3868.17, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Military Tricare", "methodology": "fee schedule", "standard_charge_dollar": 3094.54, "additional_payer_notes": "80.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3868.17, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 3868.17, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC All Payer (02-01-2023 to 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 5378.0 }, { "payer_name": "UHC", "plan_name": "UHC Medicaid (02/01/2023 to 12-31-2026)", "methodology": "percent of total billed charges", "standard_charge_percentage": 19.47, "median_amount": 3910.29, "10th_percentile": 3910.29, "90th_percentile": 3910.29, "count": "1 through 10" }, { "payer_name": "UHC", "plan_name": "UHC Oxford (02-01-2023 to 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 5169.0 }, { "payer_name": "UHC - Adhoc", "plan_name": "UHC - Adhoc All Payer", "methodology": "case rate", "standard_charge_dollar": 5709.0 }, { "payer_name": "UHC - Adhoc", "plan_name": "UHC - Adhoc Oxford", "methodology": "case rate", "standard_charge_dollar": 5327.0 }, { "payer_name": "Wellcare", "plan_name": "Wellcare Insurance Exchange", "methodology": "fee schedule", "standard_charge_dollar": 5222.03, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3868.17, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellchoice", "plan_name": "WELLCHOICE HMO of NJ (Empire) Commercial (HMO / HMO POS, PPO)", "methodology": "case rate", "standard_charge_dollar": 1715.0 }, { "payer_name": "Wellchoice", "plan_name": "WELLCHOICE HMO of NJ (Empire) Commercial (Indemnity)", "methodology": "case rate", "standard_charge_dollar": 1978.0 }, { "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3868.17, "additional_payer_notes": "100.00% of Medicare Rates" } ] } ] }, { "description": "Rerepair Fem Hernia Blocked", "code_information": [ { "code": "49557", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 21637.5, "discounted_cash": 4232.0, "minimum": 1715.0, "maximum": 17310.0, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 8973.47, "additional_payer_notes": "212.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medical Rental Network", "methodology": "fee schedule", "standard_charge_dollar": 8973.47, "additional_payer_notes": "212.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 4232.77, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "ALLY-ALIGN (FKA SPARTAN PLAN NJ, INC.)", "plan_name": "ALLY-ALIGN (FKA SPARTAN PLAN NJ, INC.)", "methodology": "fee schedule", "standard_charge_dollar": 4444.41, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Americhoice (UHC)", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 4232.77, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Amerihealth", "plan_name": "Amerihealth Medicare", "methodology": "fee schedule", "standard_charge_dollar": 4232.77, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 6220.06, "additional_payer_notes": "146.95% of Medicare Rates" }, { "payer_name": "Clover Health", "plan_name": "Clover Medicare", "methodology": "fee schedule", "standard_charge_dollar": 4232.77, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Coventry", "plan_name": "Coventry Auto", "methodology": "fee schedule", "standard_charge_dollar": 8465.54, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Coventry", "plan_name": "Coventry Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 8465.54, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "fee schedule", "standard_charge_dollar": 5925.88, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Fairprice Healthcare Holdings", "plan_name": "Fairprice Healthcare Holdings", "methodology": "fee schedule", "standard_charge_dollar": 6772.43, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ HMO POS", "methodology": "fee schedule", "standard_charge_dollar": 7504.7, "additional_payer_notes": "177.30% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ Indemnity", "methodology": "fee schedule", "standard_charge_dollar": 7504.7, "additional_payer_notes": "177.30% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ PPO", "methodology": "fee schedule", "standard_charge_dollar": 7504.7, "additional_payer_notes": "177.30% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon Medicare", "methodology": "fee schedule", "standard_charge_dollar": 4232.77, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Military Tricare", "methodology": "fee schedule", "standard_charge_dollar": 3386.22, "additional_payer_notes": "80.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 4232.77, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 4232.77, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC All Payer (02-01-2023 to 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 5378.0 }, { "payer_name": "UHC", "plan_name": "UHC Oxford (02-01-2023 to 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 5169.0 }, { "payer_name": "UHC - Adhoc", "plan_name": "UHC - Adhoc All Payer", "methodology": "case rate", "standard_charge_dollar": 5709.0 }, { "payer_name": "UHC - Adhoc", "plan_name": "UHC - Adhoc Oxford", "methodology": "case rate", "standard_charge_dollar": 5327.0 }, { "payer_name": "Wellcare", "plan_name": "Wellcare Insurance Exchange", "methodology": "fee schedule", "standard_charge_dollar": 5714.24, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 4232.77, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellchoice", "plan_name": "WELLCHOICE HMO of NJ (Empire) Commercial (HMO / HMO POS, PPO)", "methodology": "case rate", "standard_charge_dollar": 1715.0 }, { "payer_name": "Wellchoice", "plan_name": "WELLCHOICE HMO of NJ (Empire) Commercial (Indemnity)", "methodology": "case rate", "standard_charge_dollar": 1978.0 }, { "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup Medicare", "methodology": "fee schedule", "standard_charge_dollar": 4232.77, "additional_payer_notes": "100.00% of Medicare Rates" } ] } ] }, { "description": "SPINAL DISORDERS & INJURIES - SOI : 4", "code_information": [ { "code": "0404", "type": "APR-DRG" } ], "standard_charges": [ { "setting": "inpatient", "minimum": 32318.56, "maximum": 35550.41, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Better Health - Medi Medi", "methodology": "case rate", "standard_charge_dollar": 35550.41, "additional_payer_notes": "110% of State Medicaid Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Better Health Medicaid", "methodology": "case rate", "standard_charge_dollar": 35550.41, "additional_payer_notes": "110% of State Medicaid Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "case rate", "standard_charge_dollar": 32318.56, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "UBH", "plan_name": "UBH Medicaid", "methodology": "case rate", "standard_charge_dollar": 32318.56, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicaid (02/01/2023 to 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 32964.93, "additional_payer_notes": "102% of State Medicaid Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicaid", "methodology": "case rate", "standard_charge_dollar": 32318.56, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup Medicaid", "methodology": "case rate", "standard_charge_dollar": 32318.56, "additional_payer_notes": "100% of State Medicaid Rates" } ] } ] }, { "description": "Hc Replace Cv Cath Catheter Only W Subq Pump/Port", "code_information": [ { "code": "36578", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 9846.07, "discounted_cash": 3732.0, "minimum": 1715.0, "maximum": 7913.5148, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 7913.51, "additional_payer_notes": "212.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medical Rental Network", "methodology": "fee schedule", "standard_charge_dollar": 7913.51, "additional_payer_notes": "212.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3732.79, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "ALLY-ALIGN (FKA SPARTAN PLAN NJ, INC.)", "plan_name": "ALLY-ALIGN (FKA SPARTAN PLAN NJ, INC.)", "methodology": "fee schedule", "standard_charge_dollar": 3919.43, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Americhoice (UHC)", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3732.79, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Amerihealth", "plan_name": "Amerihealth Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3732.79, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 5485.33, "additional_payer_notes": "146.95% of Medicare Rates" }, { "payer_name": "Clover Health", "plan_name": "Clover Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3732.79, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Coventry", "plan_name": "Coventry Auto", "methodology": "fee schedule", "standard_charge_dollar": 7465.58, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Coventry", "plan_name": "Coventry Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 7465.58, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "fee schedule", "standard_charge_dollar": 5225.91, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Fairprice Healthcare Holdings", "plan_name": "Fairprice Healthcare Holdings", "methodology": "fee schedule", "standard_charge_dollar": 5972.46, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ HMO POS", "methodology": "fee schedule", "standard_charge_dollar": 6618.24, "additional_payer_notes": "177.30% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ Indemnity", "methodology": "fee schedule", "standard_charge_dollar": 6618.24, "additional_payer_notes": "177.30% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ PPO", "methodology": "fee schedule", "standard_charge_dollar": 6618.24, "additional_payer_notes": "177.30% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3732.79, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Military Tricare", "methodology": "fee schedule", "standard_charge_dollar": 2986.23, "additional_payer_notes": "80.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3732.79, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 3732.79, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC All Payer (02-01-2023 to 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 5378.0 }, { "payer_name": "UHC", "plan_name": "UHC Oxford (02-01-2023 to 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 5169.0 }, { "payer_name": "UHC - Adhoc", "plan_name": "UHC - Adhoc All Payer", "methodology": "case rate", "standard_charge_dollar": 5709.0 }, { "payer_name": "UHC - Adhoc", "plan_name": "UHC - Adhoc Oxford", "methodology": "case rate", "standard_charge_dollar": 5327.0 }, { "payer_name": "Wellcare", "plan_name": "Wellcare Insurance Exchange", "methodology": "fee schedule", "standard_charge_dollar": 5039.27, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3732.79, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellchoice", "plan_name": "WELLCHOICE HMO of NJ (Empire) Commercial (HMO / HMO POS, PPO)", "methodology": "case rate", "standard_charge_dollar": 1715.0 }, { "payer_name": "Wellchoice", "plan_name": "WELLCHOICE HMO of NJ (Empire) Commercial (Indemnity)", "methodology": "case rate", "standard_charge_dollar": 1978.0 }, { "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3732.79, "additional_payer_notes": "100.00% of Medicare Rates" } ] } ] }, { "description": "INSERT SPINE FIXATION DEVICE - 22846 - ", "code_information": [ { "code": "22846", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 9007.65, "minimum": 810.93, "maximum": 7206.12, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 810.93, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC All Payer (02-01-2023 to 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 6624.0 }, { "payer_name": "UHC", "plan_name": "UHC Oxford (02-01-2023 to 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 6317.0 }, { "payer_name": "UHC - Adhoc", "plan_name": "UHC - Adhoc All Payer", "methodology": "case rate", "standard_charge_dollar": 7031.0 }, { "payer_name": "UHC - Adhoc", "plan_name": "UHC - Adhoc Oxford", "methodology": "case rate", "standard_charge_dollar": 6510.0 }, { "payer_name": "Wellchoice", "plan_name": "WELLCHOICE HMO of NJ (Empire) Commercial (HMO / HMO POS, PPO)", "methodology": "case rate", "standard_charge_dollar": 1715.0 }, { "payer_name": "Wellchoice", "plan_name": "WELLCHOICE HMO of NJ (Empire) Commercial (Indemnity)", "methodology": "case rate", "standard_charge_dollar": 1978.0 } ] } ] }, { "description": "Hc Assay Of Aldolase", "code_information": [ { "code": "82085", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 79.0, "discounted_cash": 9.0, "minimum": 5.83, "maximum": 67.15, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 20.59, "additional_payer_notes": "212.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medical Rental Network", "methodology": "fee schedule", "standard_charge_dollar": 20.59, "additional_payer_notes": "212.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 9.71, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "ALLY-ALIGN (FKA SPARTAN PLAN NJ, INC.)", "plan_name": "ALLY-ALIGN (FKA SPARTAN PLAN NJ, INC.)", "methodology": "fee schedule", "standard_charge_dollar": 10.2, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Americhoice (UHC)", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 9.71, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Amerihealth", "plan_name": "Amerihealth Medicare", "methodology": "fee schedule", "standard_charge_dollar": 9.71, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 14.08, "additional_payer_notes": "Laboratory - 145.00% of Medicare Rates" }, { "payer_name": "Clover Health", "plan_name": "Clover Medicare", "methodology": "fee schedule", "standard_charge_dollar": 9.71, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Coventry", "plan_name": "Coventry Auto", "methodology": "fee schedule", "standard_charge_dollar": 19.42, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Coventry", "plan_name": "Coventry Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 19.42, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "fee schedule", "standard_charge_dollar": 13.59, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Fairprice Healthcare Holdings", "plan_name": "Fairprice Healthcare Holdings", "methodology": "fee schedule", "standard_charge_dollar": 11.65, "additional_payer_notes": "Laboratory - 120.00% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ HMO POS", "methodology": "fee schedule", "standard_charge_dollar": 55.77, "additional_payer_notes": "177.30% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ Indemnity", "methodology": "fee schedule", "standard_charge_dollar": 55.77, "additional_payer_notes": "177.30% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ PPO", "methodology": "fee schedule", "standard_charge_dollar": 55.77, "additional_payer_notes": "177.30% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon Medicare", "methodology": "fee schedule", "standard_charge_dollar": 9.71, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Military Tricare", "methodology": "fee schedule", "standard_charge_dollar": 7.77, "additional_payer_notes": "80.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 9.71, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 9.71, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC All Payer (02-01-2023 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 5.83 }, { "payer_name": "UHC", "plan_name": "UHC Medicaid (02/01/2023 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 7.77 }, { "payer_name": "UHC", "plan_name": "UHC Oxford (02-01-2023 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 5.83 }, { "payer_name": "UHC - Adhoc", "plan_name": "UHC - Adhoc All Payer", "methodology": "fee schedule", "standard_charge_dollar": 9.71 }, { "payer_name": "UHC - Adhoc", "plan_name": "UHC - Adhoc Oxford", "methodology": "fee schedule", "standard_charge_dollar": 9.71 }, { "payer_name": "Wellcare", "plan_name": "Wellcare Insurance Exchange", "methodology": "fee schedule", "standard_charge_dollar": 13.11, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 9.71, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup Medicare", "methodology": "fee schedule", "standard_charge_dollar": 9.71, "additional_payer_notes": "100.00% of Medicare Rates" } ] } ] }, { "description": "Cystoscopy And Treatment - 52310 - OR36052310", "code_information": [ { "code": "52310", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 15390.0, "discounted_cash": 2471.0, "minimum": 1715.0, "maximum": 12312.0, "payers_information": [ { "payer_name": "UHC - Adhoc", "plan_name": "UHC - Adhoc Oxford", "methodology": "case rate", "standard_charge_dollar": 3788.0 }, { "payer_name": "Wellcare", "plan_name": "Wellcare Insurance Exchange", "methodology": "fee schedule", "standard_charge_dollar": 3336.2, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2471.26, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellchoice", "plan_name": "WELLCHOICE HMO of NJ (Empire) Commercial (HMO / HMO POS, PPO)", "methodology": "case rate", "standard_charge_dollar": 1715.0 }, { "payer_name": "Wellchoice", "plan_name": "WELLCHOICE HMO of NJ (Empire) Commercial (Indemnity)", "methodology": "case rate", "standard_charge_dollar": 1978.0 }, { "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2471.26, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 5239.07, "additional_payer_notes": "212.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medical Rental Network", "methodology": "fee schedule", "standard_charge_dollar": 5239.07, "additional_payer_notes": "212.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2471.26, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "ALLY-ALIGN (FKA SPARTAN PLAN NJ, INC.)", "plan_name": "ALLY-ALIGN (FKA SPARTAN PLAN NJ, INC.)", "methodology": "fee schedule", "standard_charge_dollar": 2594.82, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Americhoice (UHC)", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2471.26, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Amerihealth", "plan_name": "Amerihealth Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2471.26, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 3631.52, "additional_payer_notes": "146.95% of Medicare Rates" }, { "payer_name": "Clover Health", "plan_name": "Clover Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2471.26, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Coventry", "plan_name": "Coventry Auto", "methodology": "fee schedule", "standard_charge_dollar": 4942.52, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Coventry", "plan_name": "Coventry Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 4942.52, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "fee schedule", "standard_charge_dollar": 3459.76, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Fairprice Healthcare Holdings", "plan_name": "Fairprice Healthcare Holdings", "methodology": "fee schedule", "standard_charge_dollar": 3954.02, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ HMO POS", "methodology": "fee schedule", "standard_charge_dollar": 4381.54, "additional_payer_notes": "177.30% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ Indemnity", "methodology": "fee schedule", "standard_charge_dollar": 4381.54, "additional_payer_notes": "177.30% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ PPO", "methodology": "fee schedule", "standard_charge_dollar": 4381.54, "additional_payer_notes": "177.30% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2471.26, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Military Tricare", "methodology": "fee schedule", "standard_charge_dollar": 1977.01, "additional_payer_notes": "80.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2471.26, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 2471.26, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC All Payer (02-01-2023 to 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 3912.0 }, { "payer_name": "UHC", "plan_name": "UHC Oxford (02-01-2023 to 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 3676.0 }, { "payer_name": "UHC - Adhoc", "plan_name": "UHC - Adhoc All Payer", "methodology": "case rate", "standard_charge_dollar": 4153.0 } ] } ] }, { "description": "ESOPHAGITIS, GASTROENTERITIS AND MISCELLANEOUS DIGESTIVE DISORDERS WITHOUT MCC", "code_information": [ { "code": "392", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 10566.0, "minimum": 4716.97, "maximum": 19124.7134, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "case rate", "standard_charge_dollar": 19124.71, "additional_payer_notes": "181.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medical Rental Network", "methodology": "case rate", "standard_charge_dollar": 19124.71, "additional_payer_notes": "181.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "case rate", "standard_charge_dollar": 8791.04, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "ALLY-ALIGN (FKA SPARTAN PLAN NJ, INC.)", "plan_name": "ALLY-ALIGN (FKA SPARTAN PLAN NJ, INC.)", "methodology": "case rate", "standard_charge_dollar": 11094.45, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Americhoice (UHC)", "plan_name": "UHC Medicare", "methodology": "case rate", "standard_charge_dollar": 8791.04, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Amerihealth", "plan_name": "Amerihealth Medicare", "methodology": "case rate", "standard_charge_dollar": 8791.04, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Commercial", "methodology": "case rate", "standard_charge_dollar": 11405.55 }, { "payer_name": "Clover Health", "plan_name": "Clover Medicare", "methodology": "case rate", "standard_charge_dollar": 8791.04, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Coventry", "plan_name": "Coventry Auto", "methodology": "case rate", "standard_charge_dollar": 17962.44, "additional_payer_notes": "170.00% of Medicare Rates" }, { "payer_name": "Coventry", "plan_name": "Coventry Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 17962.44, "additional_payer_notes": "170.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "case rate", "standard_charge_dollar": 13735.98, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Fairprice Healthcare Holdings", "plan_name": "Fairprice Healthcare Holdings", "methodology": "case rate", "standard_charge_dollar": 16905.82, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon Medicare", "methodology": "case rate", "standard_charge_dollar": 8791.04, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon NJ Health Medicaid", "methodology": "case rate", "standard_charge_dollar": 4716.97 }, { "payer_name": "Humana", "plan_name": "Humana Military Tricare", "methodology": "case rate", "standard_charge_dollar": 8452.91, "additional_payer_notes": "80.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 10566.14, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 8452.78 }, { "payer_name": "UBH", "plan_name": "UBH Medicare", "methodology": "case rate", "standard_charge_dollar": 8791.04, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC All Payer (02-01-2023 to 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 13140.94 }, { "payer_name": "UHC", "plan_name": "UHC Oxford (02-01-2023 to 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 11452.32 }, { "payer_name": "UHC - Adhoc", "plan_name": "UHC - Adhoc All Payer", "methodology": "case rate", "standard_charge_dollar": 13949.38 }, { "payer_name": "UHC - Adhoc", "plan_name": "UHC - Adhoc Oxford", "methodology": "case rate", "standard_charge_dollar": 11801.58 }, { "payer_name": "Wellcare", "plan_name": "Wellcare Insurance Exchange", "methodology": "case rate", "standard_charge_dollar": 14264.29, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "case rate", "standard_charge_dollar": 8791.04, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup Medicare", "methodology": "case rate", "standard_charge_dollar": 8791.04, "additional_payer_notes": "100.00% of Medicare Rates" } ] } ] }, { "description": "EXTENSIVE O.R. PROCEDURES UNRELATED TO PRINCIPAL DIAGNOSIS WITH MCC", "code_information": [ { "code": "981", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 55777.0, "minimum": 27290.86, "maximum": 100957.0397, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "case rate", "standard_charge_dollar": 100957.04, "additional_payer_notes": "181.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medical Rental Network", "methodology": "case rate", "standard_charge_dollar": 100957.04, "additional_payer_notes": "181.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "case rate", "standard_charge_dollar": 45094.4, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "ALLY-ALIGN (FKA SPARTAN PLAN NJ, INC.)", "plan_name": "ALLY-ALIGN (FKA SPARTAN PLAN NJ, INC.)", "methodology": "case rate", "standard_charge_dollar": 58566.24, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Americhoice (UHC)", "plan_name": "UHC Medicare", "methodology": "case rate", "standard_charge_dollar": 45094.4, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Amerihealth", "plan_name": "Amerihealth Medicare", "methodology": "case rate", "standard_charge_dollar": 45094.4, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Commercial", "methodology": "case rate", "standard_charge_dollar": 68641.03 }, { "payer_name": "Clover Health", "plan_name": "Clover Medicare", "methodology": "case rate", "standard_charge_dollar": 45094.4, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Coventry", "plan_name": "Coventry Auto", "methodology": "case rate", "standard_charge_dollar": 94821.53, "additional_payer_notes": "170.00% of Medicare Rates" }, { "payer_name": "Coventry", "plan_name": "Coventry Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 94821.53, "additional_payer_notes": "170.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "case rate", "standard_charge_dollar": 72510.58, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Fairprice Healthcare Holdings", "plan_name": "Fairprice Healthcare Holdings", "methodology": "case rate", "standard_charge_dollar": 89243.79, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon Medicare", "methodology": "case rate", "standard_charge_dollar": 45094.4, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon NJ Health Medicaid", "methodology": "case rate", "standard_charge_dollar": 27290.86 }, { "payer_name": "Humana", "plan_name": "Humana Military Tricare", "methodology": "case rate", "standard_charge_dollar": 44621.9, "additional_payer_notes": "80.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 55777.37, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 73371.0 }, { "payer_name": "UBH", "plan_name": "UBH Medicare", "methodology": "case rate", "standard_charge_dollar": 45094.4, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC All Payer (02-01-2023 to 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 79084.98 }, { "payer_name": "UHC", "plan_name": "UHC Oxford (02-01-2023 to 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 68922.54 }, { "payer_name": "UHC - Adhoc", "plan_name": "UHC - Adhoc All Payer", "methodology": "case rate", "standard_charge_dollar": 83950.38 }, { "payer_name": "UHC - Adhoc", "plan_name": "UHC - Adhoc Oxford", "methodology": "case rate", "standard_charge_dollar": 71024.47 }, { "payer_name": "Wellcare", "plan_name": "Wellcare Insurance Exchange", "methodology": "case rate", "standard_charge_dollar": 75299.45, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "case rate", "standard_charge_dollar": 45094.4, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup Medicare", "methodology": "case rate", "standard_charge_dollar": 45094.4, "additional_payer_notes": "100.00% of Medicare Rates" } ] } ] }, { "description": "EXTENSIVE 3RD DEGREE BURNS W SKIN GRAFT - SOI : 2", "code_information": [ { "code": "8412", "type": "APR-DRG" } ], "standard_charges": [ { "setting": "inpatient", "minimum": 23752.98, "maximum": 26128.27, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Better Health - Medi Medi", "methodology": "case rate", "standard_charge_dollar": 26128.27, "additional_payer_notes": "110% of State Medicaid Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Better Health Medicaid", "methodology": "case rate", "standard_charge_dollar": 26128.27, "additional_payer_notes": "110% of State Medicaid Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "case rate", "standard_charge_dollar": 23752.98, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "UBH", "plan_name": "UBH Medicaid", "methodology": "case rate", "standard_charge_dollar": 23752.98, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicaid (02/01/2023 to 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 24228.04, "additional_payer_notes": "102% of State Medicaid Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicaid", "methodology": "case rate", "standard_charge_dollar": 23752.98, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup Medicaid", "methodology": "case rate", "standard_charge_dollar": 23752.98, "additional_payer_notes": "100% of State Medicaid Rates" } ] } ] }, { "description": "ACUTE LEUKEMIA WITHOUT MAJOR O.R. PROCEDURES WITHOUT CCMCC", "code_information": [ { "code": "836", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 15649.0, "minimum": 7571.88, "maximum": 28326.2104, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "case rate", "standard_charge_dollar": 28326.21, "additional_payer_notes": "181.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medical Rental Network", "methodology": "case rate", "standard_charge_dollar": 28326.21, "additional_payer_notes": "181.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "case rate", "standard_charge_dollar": 12873.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "ALLY-ALIGN (FKA SPARTAN PLAN NJ, INC.)", "plan_name": "ALLY-ALIGN (FKA SPARTAN PLAN NJ, INC.)", "methodology": "case rate", "standard_charge_dollar": 16432.33, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Americhoice (UHC)", "plan_name": "UHC Medicare", "methodology": "case rate", "standard_charge_dollar": 12873.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Amerihealth", "plan_name": "Amerihealth Medicare", "methodology": "case rate", "standard_charge_dollar": 12873.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Commercial", "methodology": "case rate", "standard_charge_dollar": 17841.29 }, { "payer_name": "Clover Health", "plan_name": "Clover Medicare", "methodology": "case rate", "standard_charge_dollar": 12873.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Coventry", "plan_name": "Coventry Auto", "methodology": "case rate", "standard_charge_dollar": 26604.73, "additional_payer_notes": "170.00% of Medicare Rates" }, { "payer_name": "Coventry", "plan_name": "Coventry Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 26604.73, "additional_payer_notes": "170.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "case rate", "standard_charge_dollar": 20344.79, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Fairprice Healthcare Holdings", "plan_name": "Fairprice Healthcare Holdings", "methodology": "case rate", "standard_charge_dollar": 25039.74, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon Medicare", "methodology": "case rate", "standard_charge_dollar": 12873.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon NJ Health Medicaid", "methodology": "case rate", "standard_charge_dollar": 7571.88 }, { "payer_name": "Humana", "plan_name": "Humana Military Tricare", "methodology": "case rate", "standard_charge_dollar": 12519.87, "additional_payer_notes": "80.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 15649.84, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 18487.6 }, { "payer_name": "UBH", "plan_name": "UBH Medicare", "methodology": "case rate", "standard_charge_dollar": 12873.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC All Payer (02-01-2023 to 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 20555.89 }, { "payer_name": "UHC", "plan_name": "UHC Oxford (02-01-2023 to 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 17914.46 }, { "payer_name": "UHC - Adhoc", "plan_name": "UHC - Adhoc All Payer", "methodology": "case rate", "standard_charge_dollar": 21820.51 }, { "payer_name": "UHC - Adhoc", "plan_name": "UHC - Adhoc Oxford", "methodology": "case rate", "standard_charge_dollar": 18460.79 }, { "payer_name": "Wellcare", "plan_name": "Wellcare Insurance Exchange", "methodology": "case rate", "standard_charge_dollar": 21127.28, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "case rate", "standard_charge_dollar": 12873.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup Medicare", "methodology": "case rate", "standard_charge_dollar": 12873.1, "additional_payer_notes": "100.00% of Medicare Rates" } ] } ] }, { "description": "Hc Perq Vertebral Augmentation, Thoracic", "code_information": [ { "code": "22513", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 28498.0, "discounted_cash": 8578.0, "minimum": 5440.2682, "maximum": 24223.3, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 18186.06, "additional_payer_notes": "212.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medical Rental Network", "methodology": "fee schedule", "standard_charge_dollar": 18186.06, "additional_payer_notes": "212.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 8578.33, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "ALLY-ALIGN (FKA SPARTAN PLAN NJ, INC.)", "plan_name": "ALLY-ALIGN (FKA SPARTAN PLAN NJ, INC.)", "methodology": "fee schedule", "standard_charge_dollar": 9007.25, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Americhoice (UHC)", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 8578.33, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Amerihealth", "plan_name": "Amerihealth Medicare", "methodology": "fee schedule", "standard_charge_dollar": 8578.33, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 12605.86, "additional_payer_notes": "146.95% of Medicare Rates" }, { "payer_name": "Clover Health", "plan_name": "Clover Medicare", "methodology": "fee schedule", "standard_charge_dollar": 8578.33, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Coventry", "plan_name": "Coventry Auto", "methodology": "fee schedule", "standard_charge_dollar": 17156.66, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Coventry", "plan_name": "Coventry Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 17156.66, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "fee schedule", "standard_charge_dollar": 12009.66, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Fairprice Healthcare Holdings", "plan_name": "Fairprice Healthcare Holdings", "methodology": "fee schedule", "standard_charge_dollar": 13725.33, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ HMO POS", "methodology": "fee schedule", "standard_charge_dollar": 15209.38, "additional_payer_notes": "177.30% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ Indemnity", "methodology": "fee schedule", "standard_charge_dollar": 15209.38, "additional_payer_notes": "177.30% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ PPO", "methodology": "fee schedule", "standard_charge_dollar": 15209.38, "additional_payer_notes": "177.30% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon Medicare", "methodology": "fee schedule", "standard_charge_dollar": 8578.33, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Military Tricare", "methodology": "fee schedule", "standard_charge_dollar": 6862.66, "additional_payer_notes": "80.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 8578.33, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 8578.33, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC All Payer (02-01-2023 to 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 6624.0 }, { "payer_name": "UHC", "plan_name": "UHC Oxford (02-01-2023 to 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 6317.0 }, { "payer_name": "UHC - Adhoc", "plan_name": "UHC - Adhoc All Payer", "methodology": "case rate", "standard_charge_dollar": 7031.0 }, { "payer_name": "UHC - Adhoc", "plan_name": "UHC - Adhoc Oxford", "methodology": "case rate", "standard_charge_dollar": 6510.0 }, { "payer_name": "Wellcare", "plan_name": "Wellcare Insurance Exchange", "methodology": "fee schedule", "standard_charge_dollar": 11580.75, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 8578.33, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup Medicare", "methodology": "fee schedule", "standard_charge_dollar": 8578.33, "additional_payer_notes": "100.00% of Medicare Rates" } ] } ] }, { "description": "NEONATE BIRTHWT >2499G W MAJOR CARDIOVASCULAR PROCEDURE - SOI : 1", "code_information": [ { "code": "6301", "type": "APR-DRG" } ], "standard_charges": [ { "setting": "inpatient", "minimum": 27586.52, "maximum": 30345.18, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Better Health - Medi Medi", "methodology": "case rate", "standard_charge_dollar": 30345.18, "additional_payer_notes": "110% of State Medicaid Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Better Health Medicaid", "methodology": "case rate", "standard_charge_dollar": 30345.18, "additional_payer_notes": "110% of State Medicaid Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "case rate", "standard_charge_dollar": 27586.52, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "UBH", "plan_name": "UBH Medicaid", "methodology": "case rate", "standard_charge_dollar": 27586.52, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicaid (02/01/2023 to 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 28138.25, "additional_payer_notes": "102% of State Medicaid Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicaid", "methodology": "case rate", "standard_charge_dollar": 27586.52, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup Medicaid", "methodology": "case rate", "standard_charge_dollar": 27586.52, "additional_payer_notes": "100% of State Medicaid Rates" } ] } ] }, { "description": "EXC ARMELBOW LES SC < 3 CM", "code_information": [ { "code": "24075", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 7310.25, "discounted_cash": 1952.0, "minimum": 1395.5267, "maximum": 5848.2, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 4139.36, "additional_payer_notes": "212.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medical Rental Network", "methodology": "fee schedule", "standard_charge_dollar": 4139.36, "additional_payer_notes": "212.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1952.53, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "ALLY-ALIGN (FKA SPARTAN PLAN NJ, INC.)", "plan_name": "ALLY-ALIGN (FKA SPARTAN PLAN NJ, INC.)", "methodology": "fee schedule", "standard_charge_dollar": 2050.16, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Americhoice (UHC)", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1952.53, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Amerihealth", "plan_name": "Amerihealth Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1952.53, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 2869.24, "additional_payer_notes": "146.95% of Medicare Rates" }, { "payer_name": "Clover Health", "plan_name": "Clover Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1952.53, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Coventry", "plan_name": "Coventry Auto", "methodology": "fee schedule", "standard_charge_dollar": 3905.06, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Coventry", "plan_name": "Coventry Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 3905.06, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "fee schedule", "standard_charge_dollar": 2733.54, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Fairprice Healthcare Holdings", "plan_name": "Fairprice Healthcare Holdings", "methodology": "fee schedule", "standard_charge_dollar": 3124.05, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ HMO POS", "methodology": "fee schedule", "standard_charge_dollar": 3461.84, "additional_payer_notes": "177.30% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ Indemnity", "methodology": "fee schedule", "standard_charge_dollar": 3461.84, "additional_payer_notes": "177.30% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ PPO", "methodology": "fee schedule", "standard_charge_dollar": 3461.84, "additional_payer_notes": "177.30% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1952.53, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon NJ Health Medicaid", "methodology": "percent of total billed charges", "standard_charge_percentage": 19.58, "median_amount": 3013.36, "10th_percentile": 3013.36, "90th_percentile": 3013.36, "count": "1 through 10" }, { "payer_name": "Humana", "plan_name": "Humana Military Tricare", "methodology": "fee schedule", "standard_charge_dollar": 1562.02, "additional_payer_notes": "80.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1952.53, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 1952.53, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC All Payer (02-01-2023 to 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 3912.0 }, { "payer_name": "UHC", "plan_name": "UHC Oxford (02-01-2023 to 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 3676.0 }, { "payer_name": "UHC - Adhoc", "plan_name": "UHC - Adhoc All Payer", "methodology": "case rate", "standard_charge_dollar": 4153.0 }, { "payer_name": "UHC - Adhoc", "plan_name": "UHC - Adhoc Oxford", "methodology": "case rate", "standard_charge_dollar": 3788.0 }, { "payer_name": "Wellcare", "plan_name": "Wellcare Insurance Exchange", "methodology": "fee schedule", "standard_charge_dollar": 2635.92, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1952.53, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellchoice", "plan_name": "WELLCHOICE HMO of NJ (Empire) Commercial (HMO / HMO POS, PPO)", "methodology": "case rate", "standard_charge_dollar": 1715.0 }, { "payer_name": "Wellchoice", "plan_name": "WELLCHOICE HMO of NJ (Empire) Commercial (Indemnity)", "methodology": "case rate", "standard_charge_dollar": 1978.0 }, { "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1952.53, "additional_payer_notes": "100.00% of Medicare Rates" } ] } ] }, { "description": "Hc Virus Id,Inoc Test,Observ", "code_information": [ { "code": "87252", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 337.2, "discounted_cash": 26.0, "minimum": 15.64, "maximum": 286.62, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 55.27, "additional_payer_notes": "212.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medical Rental Network", "methodology": "fee schedule", "standard_charge_dollar": 55.27, "additional_payer_notes": "212.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 26.07, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "ALLY-ALIGN (FKA SPARTAN PLAN NJ, INC.)", "plan_name": "ALLY-ALIGN (FKA SPARTAN PLAN NJ, INC.)", "methodology": "fee schedule", "standard_charge_dollar": 27.37, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Americhoice (UHC)", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 26.07, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Amerihealth", "plan_name": "Amerihealth Medicare", "methodology": "fee schedule", "standard_charge_dollar": 26.07, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 37.8, "additional_payer_notes": "Laboratory - 145.00% of Medicare Rates" }, { "payer_name": "Clover Health", "plan_name": "Clover Medicare", "methodology": "fee schedule", "standard_charge_dollar": 26.07, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Coventry", "plan_name": "Coventry Auto", "methodology": "fee schedule", "standard_charge_dollar": 52.14, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Coventry", "plan_name": "Coventry Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 52.14, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "fee schedule", "standard_charge_dollar": 36.5, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Fairprice Healthcare Holdings", "plan_name": "Fairprice Healthcare Holdings", "methodology": "fee schedule", "standard_charge_dollar": 31.28, "additional_payer_notes": "Laboratory - 120.00% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ HMO POS", "methodology": "fee schedule", "standard_charge_dollar": 238.06, "additional_payer_notes": "177.30% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ Indemnity", "methodology": "fee schedule", "standard_charge_dollar": 238.06, "additional_payer_notes": "177.30% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ PPO", "methodology": "fee schedule", "standard_charge_dollar": 238.06, "additional_payer_notes": "177.30% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon Medicare", "methodology": "fee schedule", "standard_charge_dollar": 26.07, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Military Tricare", "methodology": "fee schedule", "standard_charge_dollar": 20.86, "additional_payer_notes": "80.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 26.07, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 26.07, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC All Payer (02-01-2023 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 15.64 }, { "payer_name": "UHC", "plan_name": "UHC Medicaid (02/01/2023 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 20.86 }, { "payer_name": "UHC", "plan_name": "UHC Oxford (02-01-2023 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 15.64 }, { "payer_name": "UHC - Adhoc", "plan_name": "UHC - Adhoc All Payer", "methodology": "fee schedule", "standard_charge_dollar": 26.07 }, { "payer_name": "UHC - Adhoc", "plan_name": "UHC - Adhoc Oxford", "methodology": "fee schedule", "standard_charge_dollar": 26.07 }, { "payer_name": "Wellcare", "plan_name": "Wellcare Insurance Exchange", "methodology": "fee schedule", "standard_charge_dollar": 35.19, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 26.07, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup Medicare", "methodology": "fee schedule", "standard_charge_dollar": 26.07, "additional_payer_notes": "100.00% of Medicare Rates" } ] } ] }, { "description": "RENAL DIALYSIS ACCESS DEVICE PROCEDURES- SOI : 1", "code_information": [ { "code": "4441", "type": "APR-DRG" } ], "standard_charges": [ { "setting": "inpatient", "minimum": 11311.22, "maximum": 12442.34, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Better Health - Medi Medi", "methodology": "case rate", "standard_charge_dollar": 12442.34, "additional_payer_notes": "110% of State Medicaid Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Better Health Medicaid", "methodology": "case rate", "standard_charge_dollar": 12442.34, "additional_payer_notes": "110% of State Medicaid Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "case rate", "standard_charge_dollar": 11311.22, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "UBH", "plan_name": "UBH Medicaid", "methodology": "case rate", "standard_charge_dollar": 11311.22, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicaid (02/01/2023 to 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 11537.44, "additional_payer_notes": "102% of State Medicaid Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicaid", "methodology": "case rate", "standard_charge_dollar": 11311.22, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup Medicaid", "methodology": "case rate", "standard_charge_dollar": 11311.22, "additional_payer_notes": "100% of State Medicaid Rates" } ] } ] }, { "description": "Hc Reagent Strip/Blood Glucose", "code_information": [ { "code": "82948", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 30.0, "discounted_cash": 5.0, "minimum": 3.02, "maximum": 25.5, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 10.68, "additional_payer_notes": "212.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medical Rental Network", "methodology": "fee schedule", "standard_charge_dollar": 10.68, "additional_payer_notes": "212.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5.04, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "ALLY-ALIGN (FKA SPARTAN PLAN NJ, INC.)", "plan_name": "ALLY-ALIGN (FKA SPARTAN PLAN NJ, INC.)", "methodology": "fee schedule", "standard_charge_dollar": 5.29, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Americhoice (UHC)", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5.04, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Amerihealth", "plan_name": "Amerihealth Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5.04, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 7.31, "additional_payer_notes": "Laboratory - 145.00% of Medicare Rates" }, { "payer_name": "Clover Health", "plan_name": "Clover Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5.04, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Coventry", "plan_name": "Coventry Auto", "methodology": "fee schedule", "standard_charge_dollar": 10.08, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Coventry", "plan_name": "Coventry Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 10.08, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "fee schedule", "standard_charge_dollar": 7.06, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Fairprice Healthcare Holdings", "plan_name": "Fairprice Healthcare Holdings", "methodology": "fee schedule", "standard_charge_dollar": 6.05, "additional_payer_notes": "Laboratory - 120.00% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ HMO POS", "methodology": "fee schedule", "standard_charge_dollar": 21.18, "additional_payer_notes": "177.30% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ Indemnity", "methodology": "fee schedule", "standard_charge_dollar": 21.18, "additional_payer_notes": "177.30% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ PPO", "methodology": "fee schedule", "standard_charge_dollar": 21.18, "additional_payer_notes": "177.30% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5.04, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Military Tricare", "methodology": "fee schedule", "standard_charge_dollar": 4.03, "additional_payer_notes": "80.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5.04, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 5.04, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC All Payer (02-01-2023 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 3.02 }, { "payer_name": "UHC", "plan_name": "UHC Medicaid (02/01/2023 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 4.03 }, { "payer_name": "UHC", "plan_name": "UHC Oxford (02-01-2023 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 3.02 }, { "payer_name": "UHC - Adhoc", "plan_name": "UHC - Adhoc All Payer", "methodology": "fee schedule", "standard_charge_dollar": 5.04 }, { "payer_name": "UHC - Adhoc", "plan_name": "UHC - Adhoc Oxford", "methodology": "fee schedule", "standard_charge_dollar": 5.04 }, { "payer_name": "Wellcare", "plan_name": "Wellcare Insurance Exchange", "methodology": "fee schedule", "standard_charge_dollar": 6.8, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5.04, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5.04, "additional_payer_notes": "100.00% of Medicare Rates" } ] } ] }, { "description": "POST-OPERATIVE, POST-TRAUMATIC, OTHER DEVICE INFECTIONS - SOI : 4", "code_information": [ { "code": "7214", "type": "APR-DRG" } ], "standard_charges": [ { "setting": "inpatient", "minimum": 25620.77, "maximum": 28182.85, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Better Health - Medi Medi", "methodology": "case rate", "standard_charge_dollar": 28182.85, "additional_payer_notes": "110% of State Medicaid Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Better Health Medicaid", "methodology": "case rate", "standard_charge_dollar": 28182.85, "additional_payer_notes": "110% of State Medicaid Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "case rate", "standard_charge_dollar": 25620.77, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "UBH", "plan_name": "UBH Medicaid", "methodology": "case rate", "standard_charge_dollar": 25620.77, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicaid (02/01/2023 to 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 26133.19, "additional_payer_notes": "102% of State Medicaid Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicaid", "methodology": "case rate", "standard_charge_dollar": 25620.77, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup Medicaid", "methodology": "case rate", "standard_charge_dollar": 25620.77, "additional_payer_notes": "100% of State Medicaid Rates" } ] } ] }, { "description": "Repair lower leg tendons - 27675 - ", "code_information": [ { "code": "27675", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 37492.0, "discounted_cash": 3868.0, "minimum": 1715.0, "maximum": 29993.6, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 8200.52, "additional_payer_notes": "212.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medical Rental Network", "methodology": "fee schedule", "standard_charge_dollar": 8200.52, "additional_payer_notes": "212.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3868.17, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "ALLY-ALIGN (FKA SPARTAN PLAN NJ, INC.)", "plan_name": "ALLY-ALIGN (FKA SPARTAN PLAN NJ, INC.)", "methodology": "fee schedule", "standard_charge_dollar": 4061.58, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Americhoice (UHC)", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3868.17, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Amerihealth", "plan_name": "Amerihealth Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3868.17, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 5684.28, "additional_payer_notes": "146.95% of Medicare Rates" }, { "payer_name": "Clover Health", "plan_name": "Clover Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3868.17, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Coventry", "plan_name": "Coventry Auto", "methodology": "fee schedule", "standard_charge_dollar": 7736.34, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Coventry", "plan_name": "Coventry Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 7736.34, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "fee schedule", "standard_charge_dollar": 5415.44, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Fairprice Healthcare Holdings", "plan_name": "Fairprice Healthcare Holdings", "methodology": "fee schedule", "standard_charge_dollar": 6189.07, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ HMO POS", "methodology": "fee schedule", "standard_charge_dollar": 6858.27, "additional_payer_notes": "177.30% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ Indemnity", "methodology": "fee schedule", "standard_charge_dollar": 6858.27, "additional_payer_notes": "177.30% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ PPO", "methodology": "fee schedule", "standard_charge_dollar": 6858.27, "additional_payer_notes": "177.30% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3868.17, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Military Tricare", "methodology": "fee schedule", "standard_charge_dollar": 3094.54, "additional_payer_notes": "80.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3868.17, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 3868.17, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC All Payer (02-01-2023 to 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 4415.0 }, { "payer_name": "UHC", "plan_name": "UHC Oxford (02-01-2023 to 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 4020.0 }, { "payer_name": "UHC - Adhoc", "plan_name": "UHC - Adhoc All Payer", "methodology": "case rate", "standard_charge_dollar": 4687.0 }, { "payer_name": "UHC - Adhoc", "plan_name": "UHC - Adhoc Oxford", "methodology": "case rate", "standard_charge_dollar": 4143.0 }, { "payer_name": "Wellcare", "plan_name": "Wellcare Insurance Exchange", "methodology": "fee schedule", "standard_charge_dollar": 5222.03, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3868.17, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellchoice", "plan_name": "WELLCHOICE HMO of NJ (Empire) Commercial (HMO / HMO POS, PPO)", "methodology": "case rate", "standard_charge_dollar": 1715.0 }, { "payer_name": "Wellchoice", "plan_name": "WELLCHOICE HMO of NJ (Empire) Commercial (Indemnity)", "methodology": "case rate", "standard_charge_dollar": 1978.0 }, { "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3868.17, "additional_payer_notes": "100.00% of Medicare Rates" } ] } ] }, { "description": "ACUTE LEUKEMIA - SOI : 3", "code_information": [ { "code": "6903", "type": "APR-DRG" } ], "standard_charges": [ { "setting": "inpatient", "minimum": 35051.3, "maximum": 38556.43, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Better Health - Medi Medi", "methodology": "case rate", "standard_charge_dollar": 38556.43, "additional_payer_notes": "110% of State Medicaid Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Better Health Medicaid", "methodology": "case rate", "standard_charge_dollar": 38556.43, "additional_payer_notes": "110% of State Medicaid Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "case rate", "standard_charge_dollar": 35051.3, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "UBH", "plan_name": "UBH Medicaid", "methodology": "case rate", "standard_charge_dollar": 35051.3, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicaid (02/01/2023 to 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 35752.32, "additional_payer_notes": "102% of State Medicaid Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicaid", "methodology": "case rate", "standard_charge_dollar": 35051.3, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup Medicaid", "methodology": "case rate", "standard_charge_dollar": 35051.3, "additional_payer_notes": "100% of State Medicaid Rates" } ] } ] }, { "description": "MALIGNANT BREAST DISORDERS WITH CC", "code_information": [ { "code": "598", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 14630.0, "minimum": 7257.79, "maximum": 26481.2955, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "case rate", "standard_charge_dollar": 26481.3, "additional_payer_notes": "181.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medical Rental Network", "methodology": "case rate", "standard_charge_dollar": 26481.3, "additional_payer_notes": "181.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "case rate", "standard_charge_dollar": 12054.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "ALLY-ALIGN (FKA SPARTAN PLAN NJ, INC.)", "plan_name": "ALLY-ALIGN (FKA SPARTAN PLAN NJ, INC.)", "methodology": "case rate", "standard_charge_dollar": 15362.08, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Americhoice (UHC)", "plan_name": "UHC Medicare", "methodology": "case rate", "standard_charge_dollar": 12054.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Amerihealth", "plan_name": "Amerihealth Medicare", "methodology": "case rate", "standard_charge_dollar": 12054.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Commercial", "methodology": "case rate", "standard_charge_dollar": 16550.92 }, { "payer_name": "Clover Health", "plan_name": "Clover Medicare", "methodology": "case rate", "standard_charge_dollar": 12054.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Coventry", "plan_name": "Coventry Auto", "methodology": "case rate", "standard_charge_dollar": 24871.94, "additional_payer_notes": "170.00% of Medicare Rates" }, { "payer_name": "Coventry", "plan_name": "Coventry Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 24871.94, "additional_payer_notes": "170.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "case rate", "standard_charge_dollar": 19019.72, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Fairprice Healthcare Holdings", "plan_name": "Fairprice Healthcare Holdings", "methodology": "case rate", "standard_charge_dollar": 23408.88, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon Medicare", "methodology": "case rate", "standard_charge_dollar": 12054.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon NJ Health Medicaid", "methodology": "case rate", "standard_charge_dollar": 7257.79 }, { "payer_name": "Humana", "plan_name": "Humana Military Tricare", "methodology": "case rate", "standard_charge_dollar": 11704.44, "additional_payer_notes": "80.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 14630.55, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 12141.1 }, { "payer_name": "UBH", "plan_name": "UBH Medicare", "methodology": "case rate", "standard_charge_dollar": 12054.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC All Payer (02-01-2023 to 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 19069.19 }, { "payer_name": "UHC", "plan_name": "UHC Oxford (02-01-2023 to 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 16618.8 }, { "payer_name": "UHC - Adhoc", "plan_name": "UHC - Adhoc All Payer", "methodology": "case rate", "standard_charge_dollar": 20242.35 }, { "payer_name": "UHC - Adhoc", "plan_name": "UHC - Adhoc Oxford", "methodology": "case rate", "standard_charge_dollar": 17125.62 }, { "payer_name": "Wellcare", "plan_name": "Wellcare Insurance Exchange", "methodology": "case rate", "standard_charge_dollar": 19751.24, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "case rate", "standard_charge_dollar": 12054.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup Medicare", "methodology": "case rate", "standard_charge_dollar": 12054.7, "additional_payer_notes": "100.00% of Medicare Rates" } ] } ] }, { "description": "OTHER PERIPHERAL VASCULAR AND RELATED PROCEDURES- SOI : 1", "code_information": [ { "code": "1821", "type": "APR-DRG" } ], "standard_charges": [ { "setting": "inpatient", "minimum": 22989.86, "maximum": 25288.85, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Better Health - Medi Medi", "methodology": "case rate", "standard_charge_dollar": 25288.85, "additional_payer_notes": "110% of State Medicaid Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Better Health Medicaid", "methodology": "case rate", "standard_charge_dollar": 25288.85, "additional_payer_notes": "110% of State Medicaid Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "case rate", "standard_charge_dollar": 22989.86, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "UBH", "plan_name": "UBH Medicaid", "methodology": "case rate", "standard_charge_dollar": 22989.86, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicaid (02/01/2023 to 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 23449.66, "additional_payer_notes": "102% of State Medicaid Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicaid", "methodology": "case rate", "standard_charge_dollar": 22989.86, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup Medicaid", "methodology": "case rate", "standard_charge_dollar": 22989.86, "additional_payer_notes": "100% of State Medicaid Rates" } ] } ] }, { "description": "Hc Nm Thyroid Uptake W/Blood Flow Sngle/Mult Quan", "code_information": [ { "code": "78014", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 1842.53, "discounted_cash": 472.0, "minimum": 221.05, "maximum": 1566.1505, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 1001.91, "additional_payer_notes": "212.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medical Rental Network", "methodology": "fee schedule", "standard_charge_dollar": 1001.91, "additional_payer_notes": "212.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 472.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "ALLY-ALIGN (FKA SPARTAN PLAN NJ, INC.)", "plan_name": "ALLY-ALIGN (FKA SPARTAN PLAN NJ, INC.)", "methodology": "fee schedule", "standard_charge_dollar": 496.23, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Americhoice (UHC)", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 472.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Amerihealth", "plan_name": "Amerihealth HMO", "methodology": "fee schedule", "standard_charge_dollar": 221.05 }, { "payer_name": "Amerihealth", "plan_name": "Amerihealth Medicare", "methodology": "fee schedule", "standard_charge_dollar": 472.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 694.49, "additional_payer_notes": "146.95% of Medicare Rates" }, { "payer_name": "Clover Health", "plan_name": "Clover Medicare", "methodology": "fee schedule", "standard_charge_dollar": 472.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Coventry", "plan_name": "Coventry Auto", "methodology": "fee schedule", "standard_charge_dollar": 945.2, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Coventry", "plan_name": "Coventry Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 945.2, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "fee schedule", "standard_charge_dollar": 661.64, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Fairprice Healthcare Holdings", "plan_name": "Fairprice Healthcare Holdings", "methodology": "fee schedule", "standard_charge_dollar": 756.16, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ HMO POS", "methodology": "fee schedule", "standard_charge_dollar": 837.92, "additional_payer_notes": "177.30% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ Indemnity", "methodology": "fee schedule", "standard_charge_dollar": 837.92, "additional_payer_notes": "177.30% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ PPO", "methodology": "fee schedule", "standard_charge_dollar": 837.92, "additional_payer_notes": "177.30% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon Medicare", "methodology": "fee schedule", "standard_charge_dollar": 472.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Military Tricare", "methodology": "fee schedule", "standard_charge_dollar": 378.08, "additional_payer_notes": "80.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 472.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 472.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC All Payer (02-01-2023 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 565.68 }, { "payer_name": "UHC", "plan_name": "UHC Oxford (02-01-2023 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 565.68 }, { "payer_name": "UHC - Adhoc", "plan_name": "UHC - Adhoc All Payer", "methodology": "fee schedule", "standard_charge_dollar": 377.12 }, { "payer_name": "UHC - Adhoc", "plan_name": "UHC - Adhoc Oxford", "methodology": "fee schedule", "standard_charge_dollar": 377.12 }, { "payer_name": "Wellcare", "plan_name": "Wellcare Insurance Exchange", "methodology": "fee schedule", "standard_charge_dollar": 638.01, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 472.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup Medicare", "methodology": "fee schedule", "standard_charge_dollar": 472.6, "additional_payer_notes": "100.00% of Medicare Rates" } ] } ] }, { "description": "OPEN CRANIOTOMY EXCEPT TRAUMA- SOI : 1", "code_information": [ { "code": "0211", "type": "APR-DRG" } ], "standard_charges": [ { "setting": "inpatient", "minimum": 24553.44, "maximum": 27008.78, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Better Health - Medi Medi", "methodology": "case rate", "standard_charge_dollar": 27008.78, "additional_payer_notes": "110% of State Medicaid Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Better Health Medicaid", "methodology": "case rate", "standard_charge_dollar": 27008.78, "additional_payer_notes": "110% of State Medicaid Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "case rate", "standard_charge_dollar": 24553.44, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "UBH", "plan_name": "UBH Medicaid", "methodology": "case rate", "standard_charge_dollar": 24553.44, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicaid (02/01/2023 to 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 25044.51, "additional_payer_notes": "102% of State Medicaid Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicaid", "methodology": "case rate", "standard_charge_dollar": 24553.44, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup Medicaid", "methodology": "case rate", "standard_charge_dollar": 24553.44, "additional_payer_notes": "100% of State Medicaid Rates" } ] } ] }, { "description": "BEHAVIORAL DISORDERS - SOI : 2", "code_information": [ { "code": "7582", "type": "APR-DRG" } ], "standard_charges": [ { "setting": "inpatient", "minimum": 5673.01, "maximum": 6240.32, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Better Health - Medi Medi", "methodology": "case rate", "standard_charge_dollar": 6240.32, "additional_payer_notes": "110% of State Medicaid Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Better Health Medicaid", "methodology": "case rate", "standard_charge_dollar": 6240.32, "additional_payer_notes": "110% of State Medicaid Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "case rate", "standard_charge_dollar": 5673.01, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "UBH", "plan_name": "UBH Medicaid", "methodology": "case rate", "standard_charge_dollar": 5673.01, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicaid (02/01/2023 to 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 5786.47, "additional_payer_notes": "102% of State Medicaid Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicaid", "methodology": "case rate", "standard_charge_dollar": 5673.01, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup Medicaid", "methodology": "case rate", "standard_charge_dollar": 5673.01, "additional_payer_notes": "100% of State Medicaid Rates" } ] } ] }, { "description": "Hc (Sup Shell A6257) Transparent Film <= 16 Sq In - A6257 - 27200146", "code_information": [ { "code": "A6257", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "payers_information": [ { "payer_name": "Horizon", "plan_name": "Horizon NJ Health Medicaid", "methodology": "percent of total billed charges", "standard_charge_percentage": 19.58, "median_amount": 1.5, "10th_percentile": 0.98, "90th_percentile": 4.49, "count": "49" }, { "payer_name": "UHC", "plan_name": "UHC Medicaid (02/01/2023 to 12-31-2026)", "methodology": "percent of total billed charges", "standard_charge_percentage": 19.47, "median_amount": 3.87, "10th_percentile": 0.95, "90th_percentile": 5.76, "count": "1 through 10" } ] } ] }, { "description": "Removal Sutr/Staple Req Anes", "code_information": [ { "code": "15851", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 17310.0, "discounted_cash": 2439.0, "minimum": 1715.0, "maximum": 13848.0, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 5171.15, "additional_payer_notes": "212.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medical Rental Network", "methodology": "fee schedule", "standard_charge_dollar": 5171.15, "additional_payer_notes": "212.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2439.22, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "ALLY-ALIGN (FKA SPARTAN PLAN NJ, INC.)", "plan_name": "ALLY-ALIGN (FKA SPARTAN PLAN NJ, INC.)", "methodology": "fee schedule", "standard_charge_dollar": 2561.18, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Americhoice (UHC)", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2439.22, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Amerihealth", "plan_name": "Amerihealth Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2439.22, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 3584.43, "additional_payer_notes": "146.95% of Medicare Rates" }, { "payer_name": "Clover Health", "plan_name": "Clover Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2439.22, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Coventry", "plan_name": "Coventry Auto", "methodology": "fee schedule", "standard_charge_dollar": 4878.44, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Coventry", "plan_name": "Coventry Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 4878.44, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "fee schedule", "standard_charge_dollar": 3414.91, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Fairprice Healthcare Holdings", "plan_name": "Fairprice Healthcare Holdings", "methodology": "fee schedule", "standard_charge_dollar": 3902.75, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ HMO POS", "methodology": "fee schedule", "standard_charge_dollar": 4324.74, "additional_payer_notes": "177.30% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ Indemnity", "methodology": "fee schedule", "standard_charge_dollar": 4324.74, "additional_payer_notes": "177.30% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ PPO", "methodology": "fee schedule", "standard_charge_dollar": 4324.74, "additional_payer_notes": "177.30% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2439.22, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Military Tricare", "methodology": "fee schedule", "standard_charge_dollar": 1951.38, "additional_payer_notes": "80.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2439.22, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 2439.22, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC All Payer (02-01-2023 to 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 3912.0 }, { "payer_name": "UHC", "plan_name": "UHC Oxford (02-01-2023 to 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 3676.0 }, { "payer_name": "UHC - Adhoc", "plan_name": "UHC - Adhoc All Payer", "methodology": "case rate", "standard_charge_dollar": 4153.0 }, { "payer_name": "UHC - Adhoc", "plan_name": "UHC - Adhoc Oxford", "methodology": "case rate", "standard_charge_dollar": 3788.0 }, { "payer_name": "Wellcare", "plan_name": "Wellcare Insurance Exchange", "methodology": "fee schedule", "standard_charge_dollar": 3292.95, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2439.22, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellchoice", "plan_name": "WELLCHOICE HMO of NJ (Empire) Commercial (HMO / HMO POS, PPO)", "methodology": "case rate", "standard_charge_dollar": 1715.0 }, { "payer_name": "Wellchoice", "plan_name": "WELLCHOICE HMO of NJ (Empire) Commercial (Indemnity)", "methodology": "case rate", "standard_charge_dollar": 1978.0 }, { "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2439.22, "additional_payer_notes": "100.00% of Medicare Rates" } ] } ] }, { "description": "SHOULDER & ELBOW JOINT REPLACEMENT - SOI : 1", "code_information": [ { "code": "3221", "type": "APR-DRG" } ], "standard_charges": [ { "setting": "inpatient", "minimum": 22655.98, "maximum": 24921.57, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Better Health - Medi Medi", "methodology": "case rate", "standard_charge_dollar": 24921.57, "additional_payer_notes": "110% of State Medicaid Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Better Health Medicaid", "methodology": "case rate", "standard_charge_dollar": 24921.57, "additional_payer_notes": "110% of State Medicaid Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "case rate", "standard_charge_dollar": 22655.98, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "UBH", "plan_name": "UBH Medicaid", "methodology": "case rate", "standard_charge_dollar": 22655.98, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicaid (02/01/2023 to 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 23109.1, "additional_payer_notes": "102% of State Medicaid Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicaid", "methodology": "case rate", "standard_charge_dollar": 22655.98, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup Medicaid", "methodology": "case rate", "standard_charge_dollar": 22655.98, "additional_payer_notes": "100% of State Medicaid Rates" } ] } ] }, { "description": "HIP & FEMUR FRACTURE REPAIR - SOI : 1", "code_information": [ { "code": "3081", "type": "APR-DRG" } ], "standard_charges": [ { "setting": "inpatient", "minimum": 17716.41, "maximum": 19488.05, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Better Health - Medi Medi", "methodology": "case rate", "standard_charge_dollar": 19488.05, "additional_payer_notes": "110% of State Medicaid Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Better Health Medicaid", "methodology": "case rate", "standard_charge_dollar": 19488.05, "additional_payer_notes": "110% of State Medicaid Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "case rate", "standard_charge_dollar": 17716.41, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "UBH", "plan_name": "UBH Medicaid", "methodology": "case rate", "standard_charge_dollar": 17716.41, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicaid (02/01/2023 to 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 18070.74, "additional_payer_notes": "102% of State Medicaid Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicaid", "methodology": "case rate", "standard_charge_dollar": 17716.41, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup Medicaid", "methodology": "case rate", "standard_charge_dollar": 17716.41, "additional_payer_notes": "100% of State Medicaid Rates" } ] } ] }, { "description": "SKIN GRAFT FOR SKIN ULCER OR CELLULITIS WITH CC", "code_information": [ { "code": "574", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 41673.0, "minimum": 19019.62, "maximum": 75429.6685, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "case rate", "standard_charge_dollar": 75429.67, "additional_payer_notes": "181.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medical Rental Network", "methodology": "case rate", "standard_charge_dollar": 75429.67, "additional_payer_notes": "181.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "case rate", "standard_charge_dollar": 33769.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "ALLY-ALIGN (FKA SPARTAN PLAN NJ, INC.)", "plan_name": "ALLY-ALIGN (FKA SPARTAN PLAN NJ, INC.)", "methodology": "case rate", "standard_charge_dollar": 43757.54, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Americhoice (UHC)", "plan_name": "UHC Medicare", "methodology": "case rate", "standard_charge_dollar": 33769.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Amerihealth", "plan_name": "Amerihealth Medicare", "methodology": "case rate", "standard_charge_dollar": 33769.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Commercial", "methodology": "case rate", "standard_charge_dollar": 50786.58 }, { "payer_name": "Clover Health", "plan_name": "Clover Medicare", "methodology": "case rate", "standard_charge_dollar": 33769.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Coventry", "plan_name": "Coventry Auto", "methodology": "case rate", "standard_charge_dollar": 70845.55, "additional_payer_notes": "170.00% of Medicare Rates" }, { "payer_name": "Coventry", "plan_name": "Coventry Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 70845.55, "additional_payer_notes": "170.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "case rate", "standard_charge_dollar": 54176.01, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Fairprice Healthcare Holdings", "plan_name": "Fairprice Healthcare Holdings", "methodology": "case rate", "standard_charge_dollar": 66678.16, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon Medicare", "methodology": "case rate", "standard_charge_dollar": 33769.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon NJ Health Medicaid", "methodology": "case rate", "standard_charge_dollar": 19019.62 }, { "payer_name": "Humana", "plan_name": "Humana Military Tricare", "methodology": "case rate", "standard_charge_dollar": 33339.08, "additional_payer_notes": "80.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 41673.85, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 29704.6 }, { "payer_name": "UBH", "plan_name": "UBH Medicare", "methodology": "case rate", "standard_charge_dollar": 33769.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC All Payer (02-01-2023 to 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 58513.92 }, { "payer_name": "UHC", "plan_name": "UHC Oxford (02-01-2023 to 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 50994.87 }, { "payer_name": "UHC - Adhoc", "plan_name": "UHC - Adhoc All Payer", "methodology": "case rate", "standard_charge_dollar": 62113.76 }, { "payer_name": "UHC - Adhoc", "plan_name": "UHC - Adhoc Oxford", "methodology": "case rate", "standard_charge_dollar": 52550.05 }, { "payer_name": "Wellcare", "plan_name": "Wellcare Insurance Exchange", "methodology": "case rate", "standard_charge_dollar": 56259.7, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "case rate", "standard_charge_dollar": 33769.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup Medicare", "methodology": "case rate", "standard_charge_dollar": 33769.7, "additional_payer_notes": "100.00% of Medicare Rates" } ] } ] }, { "description": "Hc Ro Radn Treatment Aid(S) Simple", "code_information": [ { "code": "77332", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 734.5, "discounted_cash": 158.0, "minimum": 127.12, "maximum": 734.5, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 336.87, "additional_payer_notes": "212.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medical Rental Network", "methodology": "fee schedule", "standard_charge_dollar": 336.87, "additional_payer_notes": "212.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 158.9, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "ALLY-ALIGN (FKA SPARTAN PLAN NJ, INC.)", "plan_name": "ALLY-ALIGN (FKA SPARTAN PLAN NJ, INC.)", "methodology": "fee schedule", "standard_charge_dollar": 166.85, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Americhoice (UHC)", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 158.9, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Amerihealth", "plan_name": "Amerihealth Medicare", "methodology": "fee schedule", "standard_charge_dollar": 158.9, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 233.5, "additional_payer_notes": "146.95% of Medicare Rates" }, { "payer_name": "Clover Health", "plan_name": "Clover Medicare", "methodology": "fee schedule", "standard_charge_dollar": 158.9, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Coventry", "plan_name": "Coventry Auto", "methodology": "fee schedule", "standard_charge_dollar": 317.8, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Coventry", "plan_name": "Coventry Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 317.8, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "fee schedule", "standard_charge_dollar": 222.46, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Fairprice Healthcare Holdings", "plan_name": "Fairprice Healthcare Holdings", "methodology": "fee schedule", "standard_charge_dollar": 254.24, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ HMO POS", "methodology": "fee schedule", "standard_charge_dollar": 281.73, "additional_payer_notes": "177.30% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ Indemnity", "methodology": "fee schedule", "standard_charge_dollar": 281.73, "additional_payer_notes": "177.30% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ PPO", "methodology": "fee schedule", "standard_charge_dollar": 281.73, "additional_payer_notes": "177.30% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon Medicare", "methodology": "fee schedule", "standard_charge_dollar": 158.9, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Military Tricare", "methodology": "fee schedule", "standard_charge_dollar": 127.12, "additional_payer_notes": "80.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 158.9, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 158.9, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC All Payer (02-01-2023 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 734.5 }, { "payer_name": "UHC", "plan_name": "UHC Oxford (02-01-2023 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 734.5 }, { "payer_name": "UHC - Adhoc", "plan_name": "UHC - Adhoc All Payer", "methodology": "fee schedule", "standard_charge_dollar": 734.5 }, { "payer_name": "UHC - Adhoc", "plan_name": "UHC - Adhoc Oxford", "methodology": "fee schedule", "standard_charge_dollar": 734.5 }, { "payer_name": "Wellcare", "plan_name": "Wellcare Insurance Exchange", "methodology": "fee schedule", "standard_charge_dollar": 214.52, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 158.9, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellchoice", "plan_name": "WELLCHOICE HMO of NJ (Empire) Commercial (HMO / HMO POS, PPO)", "methodology": "case rate", "standard_charge_dollar": 167.0 }, { "payer_name": "Wellchoice", "plan_name": "WELLCHOICE HMO of NJ (Empire) Commercial (Indemnity)", "methodology": "case rate", "standard_charge_dollar": 202.0 }, { "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup Medicare", "methodology": "fee schedule", "standard_charge_dollar": 158.9, "additional_payer_notes": "100.00% of Medicare Rates" } ] } ] }, { "description": "Hc Ct Scan Head Combo", "code_information": [ { "code": "70470", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 2541.65, "discounted_cash": 207.0, "minimum": 165.888, "maximum": 2160.4025, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 439.6, "additional_payer_notes": "212.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medical Rental Network", "methodology": "fee schedule", "standard_charge_dollar": 439.6, "additional_payer_notes": "212.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 207.36, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "ALLY-ALIGN (FKA SPARTAN PLAN NJ, INC.)", "plan_name": "ALLY-ALIGN (FKA SPARTAN PLAN NJ, INC.)", "methodology": "fee schedule", "standard_charge_dollar": 217.73, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Americhoice (UHC)", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 207.36, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Amerihealth", "plan_name": "Amerihealth HMO", "methodology": "fee schedule", "standard_charge_dollar": 525.51 }, { "payer_name": "Amerihealth", "plan_name": "Amerihealth Medicare", "methodology": "fee schedule", "standard_charge_dollar": 207.36, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 304.72, "additional_payer_notes": "146.95% of Medicare Rates" }, { "payer_name": "Clover Health", "plan_name": "Clover Medicare", "methodology": "fee schedule", "standard_charge_dollar": 207.36, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Coventry", "plan_name": "Coventry Auto", "methodology": "fee schedule", "standard_charge_dollar": 414.72, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Coventry", "plan_name": "Coventry Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 414.72, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "fee schedule", "standard_charge_dollar": 290.3, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Fairprice Healthcare Holdings", "plan_name": "Fairprice Healthcare Holdings", "methodology": "fee schedule", "standard_charge_dollar": 331.78, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ HMO POS", "methodology": "fee schedule", "standard_charge_dollar": 367.65, "additional_payer_notes": "177.30% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ Indemnity", "methodology": "fee schedule", "standard_charge_dollar": 367.65, "additional_payer_notes": "177.30% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ PPO", "methodology": "fee schedule", "standard_charge_dollar": 367.65, "additional_payer_notes": "177.30% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon Medicare", "methodology": "fee schedule", "standard_charge_dollar": 207.36, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Military Tricare", "methodology": "fee schedule", "standard_charge_dollar": 165.89, "additional_payer_notes": "80.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 207.36, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 207.36, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC All Payer (02-01-2023 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 267.83 }, { "payer_name": "UHC", "plan_name": "UHC Medicaid (02/01/2023 to 12-31-2026)", "methodology": "percent of total billed charges", "standard_charge_percentage": 19.47, "median_amount": 209.65, "10th_percentile": 209.65, "90th_percentile": 209.65, "count": "1 through 10" }, { "payer_name": "UHC", "plan_name": "UHC Oxford (02-01-2023 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 267.83 }, { "payer_name": "UHC - Adhoc", "plan_name": "UHC - Adhoc All Payer", "methodology": "fee schedule", "standard_charge_dollar": 178.55 }, { "payer_name": "UHC - Adhoc", "plan_name": "UHC - Adhoc Oxford", "methodology": "fee schedule", "standard_charge_dollar": 178.55 }, { "payer_name": "Wellcare", "plan_name": "Wellcare Insurance Exchange", "methodology": "fee schedule", "standard_charge_dollar": 279.94, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 207.36, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup Medicare", "methodology": "fee schedule", "standard_charge_dollar": 207.36, "additional_payer_notes": "100.00% of Medicare Rates" } ] } ] }, { "description": "OTHER KIDNEY & URINARY TRACT DIAGNOSES, SIGNS & SYMPTOMS - SOI : 1", "code_information": [ { "code": "4681", "type": "APR-DRG" } ], "standard_charges": [ { "setting": "inpatient", "minimum": 5817.41, "maximum": 6399.15, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Better Health - Medi Medi", "methodology": "case rate", "standard_charge_dollar": 6399.15, "additional_payer_notes": "110% of State Medicaid Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Better Health Medicaid", "methodology": "case rate", "standard_charge_dollar": 6399.15, "additional_payer_notes": "110% of State Medicaid Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "case rate", "standard_charge_dollar": 5817.41, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "UBH", "plan_name": "UBH Medicaid", "methodology": "case rate", "standard_charge_dollar": 5817.41, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicaid (02/01/2023 to 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 5933.75, "additional_payer_notes": "102% of State Medicaid Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicaid", "methodology": "case rate", "standard_charge_dollar": 5817.41, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup Medicaid", "methodology": "case rate", "standard_charge_dollar": 5817.41, "additional_payer_notes": "100% of State Medicaid Rates" } ] } ] }, { "description": "Removal Tunneled Cv Cath - 36590 - OR36036590", "code_information": [ { "code": "36590", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 15422.6, "discounted_cash": 1860.0, "minimum": 65.8605, "maximum": 12338.08, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 3945.26, "additional_payer_notes": "212.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medical Rental Network", "methodology": "fee schedule", "standard_charge_dollar": 3945.26, "additional_payer_notes": "212.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1860.97, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "ALLY-ALIGN (FKA SPARTAN PLAN NJ, INC.)", "plan_name": "ALLY-ALIGN (FKA SPARTAN PLAN NJ, INC.)", "methodology": "fee schedule", "standard_charge_dollar": 1954.02, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Americhoice (UHC)", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1860.97, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Amerihealth", "plan_name": "Amerihealth Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1860.97, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 2734.7, "additional_payer_notes": "146.95% of Medicare Rates" }, { "payer_name": "Clover Health", "plan_name": "Clover Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1860.97, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Coventry", "plan_name": "Coventry Auto", "methodology": "fee schedule", "standard_charge_dollar": 3721.94, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Coventry", "plan_name": "Coventry Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 3721.94, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "fee schedule", "standard_charge_dollar": 2605.36, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Fairprice Healthcare Holdings", "plan_name": "Fairprice Healthcare Holdings", "methodology": "fee schedule", "standard_charge_dollar": 2977.55, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ HMO POS", "methodology": "fee schedule", "standard_charge_dollar": 3299.5, "additional_payer_notes": "177.30% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ Indemnity", "methodology": "fee schedule", "standard_charge_dollar": 3299.5, "additional_payer_notes": "177.30% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ PPO", "methodology": "fee schedule", "standard_charge_dollar": 3299.5, "additional_payer_notes": "177.30% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1860.97, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon NJ Health Medicaid", "methodology": "percent of total billed charges", "standard_charge_percentage": 19.58, "median_amount": 3013.36, "10th_percentile": 3013.36, "90th_percentile": 3013.36, "count": "1 through 10" }, { "payer_name": "Humana", "plan_name": "Humana Military Tricare", "methodology": "fee schedule", "standard_charge_dollar": 1488.78, "additional_payer_notes": "80.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1860.97, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 1860.97, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC All Payer (02-01-2023 to 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 3912.0 }, { "payer_name": "UHC", "plan_name": "UHC Medicaid (02/01/2023 to 12-31-2026)", "methodology": "percent of total billed charges", "standard_charge_percentage": 19.47, "median_amount": 2927.64, "10th_percentile": 2927.64, "90th_percentile": 2927.64, "count": "1 through 10" }, { "payer_name": "UHC", "plan_name": "UHC Oxford (02-01-2023 to 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 3676.0 }, { "payer_name": "UHC - Adhoc", "plan_name": "UHC - Adhoc All Payer", "methodology": "case rate", "standard_charge_dollar": 4153.0 }, { "payer_name": "UHC - Adhoc", "plan_name": "UHC - Adhoc Oxford", "methodology": "case rate", "standard_charge_dollar": 3788.0 }, { "payer_name": "Wellcare", "plan_name": "Wellcare Insurance Exchange", "methodology": "fee schedule", "standard_charge_dollar": 2512.31, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1860.97, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellchoice", "plan_name": "WELLCHOICE HMO of NJ (Empire) Commercial (HMO / HMO POS, PPO)", "methodology": "case rate", "standard_charge_dollar": 1715.0 }, { "payer_name": "Wellchoice", "plan_name": "WELLCHOICE HMO of NJ (Empire) Commercial (Indemnity)", "methodology": "case rate", "standard_charge_dollar": 1978.0 }, { "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1860.97, "additional_payer_notes": "100.00% of Medicare Rates" } ] } ] }, { "description": "OTHER INJURY, POISONING & TOXIC EFFECT DIAGNOSES - SOI : 2", "code_information": [ { "code": "8152", "type": "APR-DRG" } ], "standard_charges": [ { "setting": "inpatient", "minimum": 6739.08, "maximum": 7412.99, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Better Health - Medi Medi", "methodology": "case rate", "standard_charge_dollar": 7412.99, "additional_payer_notes": "110% of State Medicaid Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Better Health Medicaid", "methodology": "case rate", "standard_charge_dollar": 7412.99, "additional_payer_notes": "110% of State Medicaid Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "case rate", "standard_charge_dollar": 6739.08, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "UBH", "plan_name": "UBH Medicaid", "methodology": "case rate", "standard_charge_dollar": 6739.08, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicaid (02/01/2023 to 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 6873.86, "additional_payer_notes": "102% of State Medicaid Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicaid", "methodology": "case rate", "standard_charge_dollar": 6739.08, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup Medicaid", "methodology": "case rate", "standard_charge_dollar": 6739.08, "additional_payer_notes": "100% of State Medicaid Rates" } ] } ] }, { "description": "Hc Hpv Low-Risk Types", "code_information": [ { "code": "87623", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 105.0, "discounted_cash": 35.0, "minimum": 20.0445, "maximum": 89.25, "payers_information": [ { "payer_name": "Americhoice (UHC)", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 35.09, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Amerihealth", "plan_name": "Amerihealth Medicare", "methodology": "fee schedule", "standard_charge_dollar": 35.09, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 50.88, "additional_payer_notes": "Laboratory - 145.00% of Medicare Rates" }, { "payer_name": "Clover Health", "plan_name": "Clover Medicare", "methodology": "fee schedule", "standard_charge_dollar": 35.09, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Coventry", "plan_name": "Coventry Auto", "methodology": "fee schedule", "standard_charge_dollar": 70.18, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Coventry", "plan_name": "Coventry Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 70.18, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "fee schedule", "standard_charge_dollar": 49.13, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Fairprice Healthcare Holdings", "plan_name": "Fairprice Healthcare Holdings", "methodology": "fee schedule", "standard_charge_dollar": 42.11, "additional_payer_notes": "Laboratory - 120.00% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ HMO POS", "methodology": "fee schedule", "standard_charge_dollar": 74.13, "additional_payer_notes": "177.30% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ Indemnity", "methodology": "fee schedule", "standard_charge_dollar": 74.13, "additional_payer_notes": "177.30% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ PPO", "methodology": "fee schedule", "standard_charge_dollar": 74.13, "additional_payer_notes": "177.30% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon Medicare", "methodology": "fee schedule", "standard_charge_dollar": 35.09, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Military Tricare", "methodology": "fee schedule", "standard_charge_dollar": 28.07, "additional_payer_notes": "80.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 35.09, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 35.09, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC All Payer (02-01-2023 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 21.05 }, { "payer_name": "UHC", "plan_name": "UHC Medicaid (02/01/2023 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 28.07 }, { "payer_name": "UHC", "plan_name": "UHC Oxford (02-01-2023 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 21.05 }, { "payer_name": "UHC - Adhoc", "plan_name": "UHC - Adhoc All Payer", "methodology": "fee schedule", "standard_charge_dollar": 35.09 }, { "payer_name": "UHC - Adhoc", "plan_name": "UHC - Adhoc Oxford", "methodology": "fee schedule", "standard_charge_dollar": 35.09 }, { "payer_name": "Wellcare", "plan_name": "Wellcare Insurance Exchange", "methodology": "fee schedule", "standard_charge_dollar": 47.37, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 35.09, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup Medicare", "methodology": "fee schedule", "standard_charge_dollar": 35.09, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 74.39, "additional_payer_notes": "212.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medical Rental Network", "methodology": "fee schedule", "standard_charge_dollar": 74.39, "additional_payer_notes": "212.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 35.09, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "ALLY-ALIGN (FKA SPARTAN PLAN NJ, INC.)", "plan_name": "ALLY-ALIGN (FKA SPARTAN PLAN NJ, INC.)", "methodology": "fee schedule", "standard_charge_dollar": 36.84, "additional_payer_notes": "105.00% of Medicare Rates" } ] } ] }, { "description": "Hc Chest X-Ray 1 Vw", "code_information": [ { "code": "71045", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 373.03, "discounted_cash": 102.0, "minimum": 54.81, "maximum": 317.0755, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 218.08, "additional_payer_notes": "212.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medical Rental Network", "methodology": "fee schedule", "standard_charge_dollar": 218.08, "additional_payer_notes": "212.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 102.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "ALLY-ALIGN (FKA SPARTAN PLAN NJ, INC.)", "plan_name": "ALLY-ALIGN (FKA SPARTAN PLAN NJ, INC.)", "methodology": "fee schedule", "standard_charge_dollar": 108.01, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Americhoice (UHC)", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 102.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Amerihealth", "plan_name": "Amerihealth HMO", "methodology": "fee schedule", "standard_charge_dollar": 54.81 }, { "payer_name": "Amerihealth", "plan_name": "Amerihealth Medicare", "methodology": "fee schedule", "standard_charge_dollar": 102.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 151.17, "additional_payer_notes": "146.95% of Medicare Rates" }, { "payer_name": "Clover Health", "plan_name": "Clover Medicare", "methodology": "fee schedule", "standard_charge_dollar": 102.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Coventry", "plan_name": "Coventry Auto", "methodology": "fee schedule", "standard_charge_dollar": 205.74, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Coventry", "plan_name": "Coventry Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 205.74, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "fee schedule", "standard_charge_dollar": 144.02, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Fairprice Healthcare Holdings", "plan_name": "Fairprice Healthcare Holdings", "methodology": "fee schedule", "standard_charge_dollar": 164.59, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ HMO POS", "methodology": "fee schedule", "standard_charge_dollar": 182.39, "additional_payer_notes": "177.30% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ Indemnity", "methodology": "fee schedule", "standard_charge_dollar": 182.39, "additional_payer_notes": "177.30% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ PPO", "methodology": "fee schedule", "standard_charge_dollar": 182.39, "additional_payer_notes": "177.30% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon Medicare", "methodology": "fee schedule", "standard_charge_dollar": 102.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon NJ Health Medicaid", "methodology": "percent of total billed charges", "standard_charge_percentage": 19.58, "median_amount": 73.04, "10th_percentile": 68.33, "90th_percentile": 73.04, "count": "565" }, { "payer_name": "Humana", "plan_name": "Humana Military Tricare", "methodology": "fee schedule", "standard_charge_dollar": 82.3, "additional_payer_notes": "80.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 102.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 102.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC All Payer (02-01-2023 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 121.35 }, { "payer_name": "UHC", "plan_name": "UHC Medicaid (02/01/2023 to 12-31-2026)", "methodology": "percent of total billed charges", "standard_charge_percentage": 19.47, "median_amount": 70.96, "10th_percentile": 66.39, "90th_percentile": 103.69, "count": "160" }, { "payer_name": "UHC", "plan_name": "UHC Oxford (02-01-2023 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 121.35 }, { "payer_name": "UHC - Adhoc", "plan_name": "UHC - Adhoc All Payer", "methodology": "fee schedule", "standard_charge_dollar": 80.9 }, { "payer_name": "UHC - Adhoc", "plan_name": "UHC - Adhoc Oxford", "methodology": "fee schedule", "standard_charge_dollar": 80.9 }, { "payer_name": "Wellcare", "plan_name": "Wellcare Insurance Exchange", "methodology": "fee schedule", "standard_charge_dollar": 138.87, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 102.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup Medicaid", "methodology": "percent of total billed charges", "standard_charge_percentage": 19.09, "median_amount": 69.57, "10th_percentile": 65.09, "90th_percentile": 71.21, "count": "151" }, { "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup Medicare", "methodology": "fee schedule", "standard_charge_dollar": 102.87, "additional_payer_notes": "100.00% of Medicare Rates" } ] } ] }, { "description": "Hc Us,Pregnant Uterus,Limited, 1/> Fetuses", "code_information": [ { "code": "76815", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 767.9, "discounted_cash": 123.0, "minimum": 98.872, "maximum": 652.715, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 262.01, "additional_payer_notes": "212.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medical Rental Network", "methodology": "fee schedule", "standard_charge_dollar": 262.01, "additional_payer_notes": "212.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 123.59, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "ALLY-ALIGN (FKA SPARTAN PLAN NJ, INC.)", "plan_name": "ALLY-ALIGN (FKA SPARTAN PLAN NJ, INC.)", "methodology": "fee schedule", "standard_charge_dollar": 129.77, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Americhoice (UHC)", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 123.59, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Amerihealth", "plan_name": "Amerihealth HMO", "methodology": "fee schedule", "standard_charge_dollar": 138.63 }, { "payer_name": "Amerihealth", "plan_name": "Amerihealth Medicare", "methodology": "fee schedule", "standard_charge_dollar": 123.59, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 181.62, "additional_payer_notes": "146.95% of Medicare Rates" }, { "payer_name": "Clover Health", "plan_name": "Clover Medicare", "methodology": "fee schedule", "standard_charge_dollar": 123.59, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Coventry", "plan_name": "Coventry Auto", "methodology": "fee schedule", "standard_charge_dollar": 247.18, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Coventry", "plan_name": "Coventry Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 247.18, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "fee schedule", "standard_charge_dollar": 173.03, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Fairprice Healthcare Holdings", "plan_name": "Fairprice Healthcare Holdings", "methodology": "fee schedule", "standard_charge_dollar": 197.74, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ HMO POS", "methodology": "fee schedule", "standard_charge_dollar": 219.13, "additional_payer_notes": "177.30% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ Indemnity", "methodology": "fee schedule", "standard_charge_dollar": 219.13, "additional_payer_notes": "177.30% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ PPO", "methodology": "fee schedule", "standard_charge_dollar": 219.13, "additional_payer_notes": "177.30% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon Medicare", "methodology": "fee schedule", "standard_charge_dollar": 123.59, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon NJ Health Medicaid", "methodology": "percent of total billed charges", "standard_charge_percentage": 19.58, "median_amount": 150.35, "10th_percentile": 150.35, "90th_percentile": 150.35, "count": "1 through 10" }, { "payer_name": "Humana", "plan_name": "Humana Military Tricare", "methodology": "fee schedule", "standard_charge_dollar": 98.87, "additional_payer_notes": "80.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 123.59, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 123.59, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC All Payer (02-01-2023 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 163.46 }, { "payer_name": "UHC", "plan_name": "UHC Oxford (02-01-2023 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 163.46 }, { "payer_name": "UHC - Adhoc", "plan_name": "UHC - Adhoc All Payer", "methodology": "fee schedule", "standard_charge_dollar": 108.97 }, { "payer_name": "UHC - Adhoc", "plan_name": "UHC - Adhoc Oxford", "methodology": "fee schedule", "standard_charge_dollar": 108.97 }, { "payer_name": "Wellcare", "plan_name": "Wellcare Insurance Exchange", "methodology": "fee schedule", "standard_charge_dollar": 166.85, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 123.59, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup Medicare", "methodology": "fee schedule", "standard_charge_dollar": 123.59, "additional_payer_notes": "100.00% of Medicare Rates" } ] } ] }, { "description": "Hc Guide Rad Therapy Fields", "code_information": [ { "code": "77387", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 231.0, "minimum": 44.0979, "maximum": 231.0, "payers_information": [ { "payer_name": "UHC", "plan_name": "UHC All Payer (02-01-2023 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 231.0 }, { "payer_name": "UHC", "plan_name": "UHC Oxford (02-01-2023 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 231.0 }, { "payer_name": "UHC - Adhoc", "plan_name": "UHC - Adhoc All Payer", "methodology": "fee schedule", "standard_charge_dollar": 231.0 }, { "payer_name": "UHC - Adhoc", "plan_name": "UHC - Adhoc Oxford", "methodology": "fee schedule", "standard_charge_dollar": 231.0 }, { "payer_name": "Wellchoice", "plan_name": "WELLCHOICE HMO of NJ (Empire) Commercial (HMO / HMO POS, PPO)", "methodology": "case rate", "standard_charge_dollar": 167.0 }, { "payer_name": "Wellchoice", "plan_name": "WELLCHOICE HMO of NJ (Empire) Commercial (Indemnity)", "methodology": "case rate", "standard_charge_dollar": 202.0 } ] } ] }, { "description": "Hc Inc/Drain Peritonsil Abscess", "code_information": [ { "code": "42700", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 1002.73, "discounted_cash": 280.0, "minimum": 191.4212, "maximum": 1002.73, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 593.6, "additional_payer_notes": "212.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medical Rental Network", "methodology": "fee schedule", "standard_charge_dollar": 593.6, "additional_payer_notes": "212.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 280.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "ALLY-ALIGN (FKA SPARTAN PLAN NJ, INC.)", "plan_name": "ALLY-ALIGN (FKA SPARTAN PLAN NJ, INC.)", "methodology": "fee schedule", "standard_charge_dollar": 294.0, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Americhoice (UHC)", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 280.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Amerihealth", "plan_name": "Amerihealth Medicare", "methodology": "fee schedule", "standard_charge_dollar": 280.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 411.46, "additional_payer_notes": "146.95% of Medicare Rates" }, { "payer_name": "Clover Health", "plan_name": "Clover Medicare", "methodology": "fee schedule", "standard_charge_dollar": 280.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Coventry", "plan_name": "Coventry Auto", "methodology": "fee schedule", "standard_charge_dollar": 560.0, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Coventry", "plan_name": "Coventry Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 560.0, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "fee schedule", "standard_charge_dollar": 392.0, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Fairprice Healthcare Holdings", "plan_name": "Fairprice Healthcare Holdings", "methodology": "fee schedule", "standard_charge_dollar": 448.0, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ HMO POS", "methodology": "fee schedule", "standard_charge_dollar": 496.44, "additional_payer_notes": "177.30% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ Indemnity", "methodology": "fee schedule", "standard_charge_dollar": 496.44, "additional_payer_notes": "177.30% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ PPO", "methodology": "fee schedule", "standard_charge_dollar": 496.44, "additional_payer_notes": "177.30% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon Medicare", "methodology": "fee schedule", "standard_charge_dollar": 280.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Military Tricare", "methodology": "fee schedule", "standard_charge_dollar": 224.0, "additional_payer_notes": "80.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 280.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 280.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC All Payer (02-01-2023 to 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 1002.73 }, { "payer_name": "UHC", "plan_name": "UHC Oxford (02-01-2023 to 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 1002.73 }, { "payer_name": "UHC - Adhoc", "plan_name": "UHC - Adhoc All Payer", "methodology": "case rate", "standard_charge_dollar": 1002.73 }, { "payer_name": "UHC - Adhoc", "plan_name": "UHC - Adhoc Oxford", "methodology": "case rate", "standard_charge_dollar": 1002.73 }, { "payer_name": "Wellcare", "plan_name": "Wellcare Insurance Exchange", "methodology": "fee schedule", "standard_charge_dollar": 378.0, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 280.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellchoice", "plan_name": "WELLCHOICE HMO of NJ (Empire) Commercial (HMO / HMO POS, PPO)", "methodology": "case rate", "standard_charge_dollar": 1002.73 }, { "payer_name": "Wellchoice", "plan_name": "WELLCHOICE HMO of NJ (Empire) Commercial (Indemnity)", "methodology": "case rate", "standard_charge_dollar": 1002.73 }, { "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup Medicare", "methodology": "fee schedule", "standard_charge_dollar": 280.0, "additional_payer_notes": "100.00% of Medicare Rates" } ] } ] }, { "description": "Hc Assay Of Citrate", "code_information": [ { "code": "82507", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 485.0, "discounted_cash": 27.0, "minimum": 16.68, "maximum": 412.25, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 58.94, "additional_payer_notes": "212.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medical Rental Network", "methodology": "fee schedule", "standard_charge_dollar": 58.94, "additional_payer_notes": "212.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 27.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "ALLY-ALIGN (FKA SPARTAN PLAN NJ, INC.)", "plan_name": "ALLY-ALIGN (FKA SPARTAN PLAN NJ, INC.)", "methodology": "fee schedule", "standard_charge_dollar": 29.19, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Americhoice (UHC)", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 27.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Amerihealth", "plan_name": "Amerihealth Medicare", "methodology": "fee schedule", "standard_charge_dollar": 27.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 40.31, "additional_payer_notes": "Laboratory - 145.00% of Medicare Rates" }, { "payer_name": "Clover Health", "plan_name": "Clover Medicare", "methodology": "fee schedule", "standard_charge_dollar": 27.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Coventry", "plan_name": "Coventry Auto", "methodology": "fee schedule", "standard_charge_dollar": 55.6, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Coventry", "plan_name": "Coventry Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 55.6, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "fee schedule", "standard_charge_dollar": 38.92, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Fairprice Healthcare Holdings", "plan_name": "Fairprice Healthcare Holdings", "methodology": "fee schedule", "standard_charge_dollar": 33.36, "additional_payer_notes": "Laboratory - 120.00% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ HMO POS", "methodology": "fee schedule", "standard_charge_dollar": 342.41, "additional_payer_notes": "177.30% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ Indemnity", "methodology": "fee schedule", "standard_charge_dollar": 342.41, "additional_payer_notes": "177.30% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ PPO", "methodology": "fee schedule", "standard_charge_dollar": 342.41, "additional_payer_notes": "177.30% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon Medicare", "methodology": "fee schedule", "standard_charge_dollar": 27.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Military Tricare", "methodology": "fee schedule", "standard_charge_dollar": 22.24, "additional_payer_notes": "80.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 27.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 27.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC All Payer (02-01-2023 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 16.68 }, { "payer_name": "UHC", "plan_name": "UHC Medicaid (02/01/2023 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 22.24 }, { "payer_name": "UHC", "plan_name": "UHC Oxford (02-01-2023 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 16.68 }, { "payer_name": "UHC - Adhoc", "plan_name": "UHC - Adhoc All Payer", "methodology": "fee schedule", "standard_charge_dollar": 27.8 }, { "payer_name": "UHC - Adhoc", "plan_name": "UHC - Adhoc Oxford", "methodology": "fee schedule", "standard_charge_dollar": 27.8 }, { "payer_name": "Wellcare", "plan_name": "Wellcare Insurance Exchange", "methodology": "fee schedule", "standard_charge_dollar": 37.53, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 27.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup Medicare", "methodology": "fee schedule", "standard_charge_dollar": 27.8, "additional_payer_notes": "100.00% of Medicare Rates" } ] } ] }, { "description": "OPIOID ABUSE & DEPENDENCE - SOI : 4", "code_information": [ { "code": "7734", "type": "APR-DRG" } ], "standard_charges": [ { "setting": "inpatient", "minimum": 22688.18, "maximum": 24957.0, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Better Health - Medi Medi", "methodology": "case rate", "standard_charge_dollar": 24957.0, "additional_payer_notes": "110% of State Medicaid Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Better Health Medicaid", "methodology": "case rate", "standard_charge_dollar": 24957.0, "additional_payer_notes": "110% of State Medicaid Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "case rate", "standard_charge_dollar": 22688.18, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "UBH", "plan_name": "UBH Medicaid", "methodology": "case rate", "standard_charge_dollar": 22688.18, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicaid (02/01/2023 to 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 23141.94, "additional_payer_notes": "102% of State Medicaid Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicaid", "methodology": "case rate", "standard_charge_dollar": 22688.18, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup Medicaid", "methodology": "case rate", "standard_charge_dollar": 22688.18, "additional_payer_notes": "100% of State Medicaid Rates" } ] } ] }, { "description": "Hc X-Ray Exam, Breast Specimen", "code_information": [ { "code": "76098", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 2264.76, "discounted_cash": 645.0, "minimum": 37.08, "maximum": 1925.046, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 1369.46, "additional_payer_notes": "212.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medical Rental Network", "methodology": "fee schedule", "standard_charge_dollar": 1369.46, "additional_payer_notes": "212.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 645.97, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "ALLY-ALIGN (FKA SPARTAN PLAN NJ, INC.)", "plan_name": "ALLY-ALIGN (FKA SPARTAN PLAN NJ, INC.)", "methodology": "fee schedule", "standard_charge_dollar": 678.27, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Americhoice (UHC)", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 645.97, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Amerihealth", "plan_name": "Amerihealth HMO", "methodology": "fee schedule", "standard_charge_dollar": 37.08 }, { "payer_name": "Amerihealth", "plan_name": "Amerihealth Medicare", "methodology": "fee schedule", "standard_charge_dollar": 645.97, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 949.25, "additional_payer_notes": "146.95% of Medicare Rates" }, { "payer_name": "Clover Health", "plan_name": "Clover Medicare", "methodology": "fee schedule", "standard_charge_dollar": 645.97, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Coventry", "plan_name": "Coventry Auto", "methodology": "fee schedule", "standard_charge_dollar": 1291.94, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Coventry", "plan_name": "Coventry Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 1291.94, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "fee schedule", "standard_charge_dollar": 904.36, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Fairprice Healthcare Holdings", "plan_name": "Fairprice Healthcare Holdings", "methodology": "fee schedule", "standard_charge_dollar": 1033.55, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ HMO POS", "methodology": "fee schedule", "standard_charge_dollar": 1145.3, "additional_payer_notes": "177.30% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ Indemnity", "methodology": "fee schedule", "standard_charge_dollar": 1145.3, "additional_payer_notes": "177.30% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ PPO", "methodology": "fee schedule", "standard_charge_dollar": 1145.3, "additional_payer_notes": "177.30% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon Medicare", "methodology": "fee schedule", "standard_charge_dollar": 645.97, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Military Tricare", "methodology": "fee schedule", "standard_charge_dollar": 516.78, "additional_payer_notes": "80.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 645.97, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 645.97, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC All Payer (02-01-2023 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 724.34 }, { "payer_name": "UHC", "plan_name": "UHC Oxford (02-01-2023 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 724.34 }, { "payer_name": "UHC - Adhoc", "plan_name": "UHC - Adhoc All Payer", "methodology": "fee schedule", "standard_charge_dollar": 482.89 }, { "payer_name": "UHC - Adhoc", "plan_name": "UHC - Adhoc Oxford", "methodology": "fee schedule", "standard_charge_dollar": 482.89 }, { "payer_name": "Wellcare", "plan_name": "Wellcare Insurance Exchange", "methodology": "fee schedule", "standard_charge_dollar": 872.06, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 645.97, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup Medicaid", "methodology": "percent of total billed charges", "standard_charge_percentage": 19.09, "median_amount": 327.97, "10th_percentile": 327.97, "90th_percentile": 327.97, "count": "1 through 10" }, { "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup Medicare", "methodology": "fee schedule", "standard_charge_dollar": 645.97, "additional_payer_notes": "100.00% of Medicare Rates" } ] } ] }, { "description": "Hc Clsd Treat Bimalleolar Ankle Fx W/O Manip", "code_information": [ { "code": "27808", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 839.01, "discounted_cash": 291.0, "minimum": 160.167, "maximum": 839.01, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 618.19, "additional_payer_notes": "212.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medical Rental Network", "methodology": "fee schedule", "standard_charge_dollar": 618.19, "additional_payer_notes": "212.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 291.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "ALLY-ALIGN (FKA SPARTAN PLAN NJ, INC.)", "plan_name": "ALLY-ALIGN (FKA SPARTAN PLAN NJ, INC.)", "methodology": "fee schedule", "standard_charge_dollar": 306.18, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Americhoice (UHC)", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 291.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Amerihealth", "plan_name": "Amerihealth Medicare", "methodology": "fee schedule", "standard_charge_dollar": 291.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 428.51, "additional_payer_notes": "146.95% of Medicare Rates" }, { "payer_name": "Clover Health", "plan_name": "Clover Medicare", "methodology": "fee schedule", "standard_charge_dollar": 291.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Coventry", "plan_name": "Coventry Auto", "methodology": "fee schedule", "standard_charge_dollar": 583.2, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Coventry", "plan_name": "Coventry Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 583.2, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "fee schedule", "standard_charge_dollar": 408.24, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Fairprice Healthcare Holdings", "plan_name": "Fairprice Healthcare Holdings", "methodology": "fee schedule", "standard_charge_dollar": 466.56, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ HMO POS", "methodology": "fee schedule", "standard_charge_dollar": 517.01, "additional_payer_notes": "177.30% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ Indemnity", "methodology": "fee schedule", "standard_charge_dollar": 517.01, "additional_payer_notes": "177.30% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ PPO", "methodology": "fee schedule", "standard_charge_dollar": 517.01, "additional_payer_notes": "177.30% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon Medicare", "methodology": "fee schedule", "standard_charge_dollar": 291.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Military Tricare", "methodology": "fee schedule", "standard_charge_dollar": 233.28, "additional_payer_notes": "80.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 291.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 291.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC All Payer (02-01-2023 to 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 839.01 }, { "payer_name": "UHC", "plan_name": "UHC Oxford (02-01-2023 to 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 839.01 }, { "payer_name": "UHC - Adhoc", "plan_name": "UHC - Adhoc All Payer", "methodology": "case rate", "standard_charge_dollar": 839.01 }, { "payer_name": "UHC - Adhoc", "plan_name": "UHC - Adhoc Oxford", "methodology": "case rate", "standard_charge_dollar": 839.01 }, { "payer_name": "Wellcare", "plan_name": "Wellcare Insurance Exchange", "methodology": "fee schedule", "standard_charge_dollar": 393.66, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 291.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup Medicare", "methodology": "fee schedule", "standard_charge_dollar": 291.6, "additional_payer_notes": "100.00% of Medicare Rates" } ] } ] }, { "description": "Incision of spinal nerve", "code_information": [ { "code": "64772", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 10260.0, "discounted_cash": 2308.0, "minimum": 1715.0, "maximum": 8208.0, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 4894.04, "additional_payer_notes": "212.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medical Rental Network", "methodology": "fee schedule", "standard_charge_dollar": 4894.04, "additional_payer_notes": "212.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2308.51, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "ALLY-ALIGN (FKA SPARTAN PLAN NJ, INC.)", "plan_name": "ALLY-ALIGN (FKA SPARTAN PLAN NJ, INC.)", "methodology": "fee schedule", "standard_charge_dollar": 2423.94, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Americhoice (UHC)", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2308.51, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Amerihealth", "plan_name": "Amerihealth Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2308.51, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 3392.36, "additional_payer_notes": "146.95% of Medicare Rates" }, { "payer_name": "Clover Health", "plan_name": "Clover Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2308.51, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Coventry", "plan_name": "Coventry Auto", "methodology": "fee schedule", "standard_charge_dollar": 4617.02, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Coventry", "plan_name": "Coventry Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 4617.02, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "fee schedule", "standard_charge_dollar": 3231.91, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Fairprice Healthcare Holdings", "plan_name": "Fairprice Healthcare Holdings", "methodology": "fee schedule", "standard_charge_dollar": 3693.62, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ HMO POS", "methodology": "fee schedule", "standard_charge_dollar": 4092.99, "additional_payer_notes": "177.30% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ Indemnity", "methodology": "fee schedule", "standard_charge_dollar": 4092.99, "additional_payer_notes": "177.30% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ PPO", "methodology": "fee schedule", "standard_charge_dollar": 4092.99, "additional_payer_notes": "177.30% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2308.51, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Military Tricare", "methodology": "fee schedule", "standard_charge_dollar": 1846.81, "additional_payer_notes": "80.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2308.51, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 2308.51, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC All Payer (02-01-2023 to 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 4415.0 }, { "payer_name": "UHC", "plan_name": "UHC Oxford (02-01-2023 to 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 4020.0 }, { "payer_name": "UHC - Adhoc", "plan_name": "UHC - Adhoc All Payer", "methodology": "case rate", "standard_charge_dollar": 4687.0 }, { "payer_name": "UHC - Adhoc", "plan_name": "UHC - Adhoc Oxford", "methodology": "case rate", "standard_charge_dollar": 4143.0 }, { "payer_name": "Wellcare", "plan_name": "Wellcare Insurance Exchange", "methodology": "fee schedule", "standard_charge_dollar": 3116.49, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2308.51, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellchoice", "plan_name": "WELLCHOICE HMO of NJ (Empire) Commercial (HMO / HMO POS, PPO)", "methodology": "case rate", "standard_charge_dollar": 1715.0 }, { "payer_name": "Wellchoice", "plan_name": "WELLCHOICE HMO of NJ (Empire) Commercial (Indemnity)", "methodology": "case rate", "standard_charge_dollar": 1978.0 }, { "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2308.51, "additional_payer_notes": "100.00% of Medicare Rates" } ] } ] }, { "description": "Hc Inj W Fluor Eval Cv Device", "code_information": [ { "code": "36598", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 935.9, "discounted_cash": 251.0, "minimum": 178.6633, "maximum": 935.9, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 533.07, "additional_payer_notes": "212.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medical Rental Network", "methodology": "fee schedule", "standard_charge_dollar": 533.07, "additional_payer_notes": "212.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 251.45, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "ALLY-ALIGN (FKA SPARTAN PLAN NJ, INC.)", "plan_name": "ALLY-ALIGN (FKA SPARTAN PLAN NJ, INC.)", "methodology": "fee schedule", "standard_charge_dollar": 264.02, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Americhoice (UHC)", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 251.45, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Amerihealth", "plan_name": "Amerihealth Medicare", "methodology": "fee schedule", "standard_charge_dollar": 251.45, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 369.51, "additional_payer_notes": "146.95% of Medicare Rates" }, { "payer_name": "Clover Health", "plan_name": "Clover Medicare", "methodology": "fee schedule", "standard_charge_dollar": 251.45, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Coventry", "plan_name": "Coventry Auto", "methodology": "fee schedule", "standard_charge_dollar": 502.9, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Coventry", "plan_name": "Coventry Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 502.9, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "fee schedule", "standard_charge_dollar": 352.03, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Fairprice Healthcare Holdings", "plan_name": "Fairprice Healthcare Holdings", "methodology": "fee schedule", "standard_charge_dollar": 402.32, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ HMO POS", "methodology": "fee schedule", "standard_charge_dollar": 445.82, "additional_payer_notes": "177.30% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ Indemnity", "methodology": "fee schedule", "standard_charge_dollar": 445.82, "additional_payer_notes": "177.30% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ PPO", "methodology": "fee schedule", "standard_charge_dollar": 445.82, "additional_payer_notes": "177.30% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon Medicare", "methodology": "fee schedule", "standard_charge_dollar": 251.45, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Military Tricare", "methodology": "fee schedule", "standard_charge_dollar": 201.16, "additional_payer_notes": "80.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 251.45, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 251.45, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC All Payer (02-01-2023 to 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 935.9 }, { "payer_name": "UHC", "plan_name": "UHC Oxford (02-01-2023 to 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 935.9 }, { "payer_name": "UHC - Adhoc", "plan_name": "UHC - Adhoc All Payer", "methodology": "case rate", "standard_charge_dollar": 935.9 }, { "payer_name": "UHC - Adhoc", "plan_name": "UHC - Adhoc Oxford", "methodology": "case rate", "standard_charge_dollar": 935.9 }, { "payer_name": "Wellcare", "plan_name": "Wellcare Insurance Exchange", "methodology": "fee schedule", "standard_charge_dollar": 339.46, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 251.45, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup Medicare", "methodology": "fee schedule", "standard_charge_dollar": 251.45, "additional_payer_notes": "100.00% of Medicare Rates" } ] } ] }, { "description": "Hc (Sup Shell C1726) Catheter Balloon Dilat Non-Vascular", "code_information": [ { "code": "C1726", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "payers_information": [ { "payer_name": "Horizon", "plan_name": "Horizon NJ Health Medicaid", "methodology": "percent of total billed charges", "standard_charge_percentage": 19.58, "median_amount": 404.13, "10th_percentile": 333.64, "90th_percentile": 404.13, "count": "1 through 10" }, { "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup Medicaid", "methodology": "percent of total billed charges", "standard_charge_percentage": 19.09, "median_amount": 402.84, "10th_percentile": 402.84, "90th_percentile": 402.84, "count": "1 through 10" } ] } ] }, { "description": "Hc Unlis Medical Radj Dosim Tx Dev Spec Svcs", "code_information": [ { "code": "77399", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 634.35, "discounted_cash": 158.0, "minimum": 121.0974, "maximum": 634.35, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 336.87, "additional_payer_notes": "212.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medical Rental Network", "methodology": "fee schedule", "standard_charge_dollar": 336.87, "additional_payer_notes": "212.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 158.9, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "ALLY-ALIGN (FKA SPARTAN PLAN NJ, INC.)", "plan_name": "ALLY-ALIGN (FKA SPARTAN PLAN NJ, INC.)", "methodology": "fee schedule", "standard_charge_dollar": 166.85, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Americhoice (UHC)", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 158.9, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Amerihealth", "plan_name": "Amerihealth Medicare", "methodology": "fee schedule", "standard_charge_dollar": 158.9, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 233.5, "additional_payer_notes": "146.95% of Medicare Rates" }, { "payer_name": "Clover Health", "plan_name": "Clover Medicare", "methodology": "fee schedule", "standard_charge_dollar": 158.9, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Coventry", "plan_name": "Coventry Auto", "methodology": "fee schedule", "standard_charge_dollar": 317.8, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Coventry", "plan_name": "Coventry Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 317.8, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "fee schedule", "standard_charge_dollar": 222.46, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Fairprice Healthcare Holdings", "plan_name": "Fairprice Healthcare Holdings", "methodology": "fee schedule", "standard_charge_dollar": 254.24, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ HMO POS", "methodology": "fee schedule", "standard_charge_dollar": 281.73, "additional_payer_notes": "177.30% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ Indemnity", "methodology": "fee schedule", "standard_charge_dollar": 281.73, "additional_payer_notes": "177.30% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ PPO", "methodology": "fee schedule", "standard_charge_dollar": 281.73, "additional_payer_notes": "177.30% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon Medicare", "methodology": "fee schedule", "standard_charge_dollar": 158.9, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Military Tricare", "methodology": "fee schedule", "standard_charge_dollar": 127.12, "additional_payer_notes": "80.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 158.9, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 158.9, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC All Payer (02-01-2023 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 634.35 }, { "payer_name": "UHC", "plan_name": "UHC Oxford (02-01-2023 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 634.35 }, { "payer_name": "UHC - Adhoc", "plan_name": "UHC - Adhoc All Payer", "methodology": "fee schedule", "standard_charge_dollar": 634.35 }, { "payer_name": "UHC - Adhoc", "plan_name": "UHC - Adhoc Oxford", "methodology": "fee schedule", "standard_charge_dollar": 634.35 }, { "payer_name": "Wellcare", "plan_name": "Wellcare Insurance Exchange", "methodology": "fee schedule", "standard_charge_dollar": 214.52, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 158.9, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellchoice", "plan_name": "WELLCHOICE HMO of NJ (Empire) Commercial (HMO / HMO POS, PPO)", "methodology": "case rate", "standard_charge_dollar": 167.0 }, { "payer_name": "Wellchoice", "plan_name": "WELLCHOICE HMO of NJ (Empire) Commercial (Indemnity)", "methodology": "case rate", "standard_charge_dollar": 202.0 }, { "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup Medicare", "methodology": "fee schedule", "standard_charge_dollar": 158.9, "additional_payer_notes": "100.00% of Medicare Rates" } ] } ] }, { "description": "TRAUMA TO THE SKIN, SUBCUTANEOUS TISSUE AND BREAST WITH MCC", "code_information": [ { "code": "604", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 18569.0, "minimum": 8846.97, "maximum": 33609.89, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "case rate", "standard_charge_dollar": 33609.89, "additional_payer_notes": "181.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medical Rental Network", "methodology": "case rate", "standard_charge_dollar": 33609.89, "additional_payer_notes": "181.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "case rate", "standard_charge_dollar": 15217.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "ALLY-ALIGN (FKA SPARTAN PLAN NJ, INC.)", "plan_name": "ALLY-ALIGN (FKA SPARTAN PLAN NJ, INC.)", "methodology": "case rate", "standard_charge_dollar": 19497.45, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Americhoice (UHC)", "plan_name": "UHC Medicare", "methodology": "case rate", "standard_charge_dollar": 15217.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Amerihealth", "plan_name": "Amerihealth Medicare", "methodology": "case rate", "standard_charge_dollar": 15217.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Commercial", "methodology": "case rate", "standard_charge_dollar": 21536.82 }, { "payer_name": "Clover Health", "plan_name": "Clover Medicare", "methodology": "case rate", "standard_charge_dollar": 15217.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Coventry", "plan_name": "Coventry Auto", "methodology": "case rate", "standard_charge_dollar": 31567.3, "additional_payer_notes": "170.00% of Medicare Rates" }, { "payer_name": "Coventry", "plan_name": "Coventry Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 31567.3, "additional_payer_notes": "170.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "case rate", "standard_charge_dollar": 24139.7, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Fairprice Healthcare Holdings", "plan_name": "Fairprice Healthcare Holdings", "methodology": "case rate", "standard_charge_dollar": 29710.4, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon Medicare", "methodology": "case rate", "standard_charge_dollar": 15217.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon NJ Health Medicaid", "methodology": "case rate", "standard_charge_dollar": 8846.97 }, { "payer_name": "Humana", "plan_name": "Humana Military Tricare", "methodology": "case rate", "standard_charge_dollar": 14855.2, "additional_payer_notes": "80.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 18569.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 21614.9 }, { "payer_name": "UBH", "plan_name": "UBH Medicare", "methodology": "case rate", "standard_charge_dollar": 15217.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC All Payer (02-01-2023 to 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 24813.72 }, { "payer_name": "UHC", "plan_name": "UHC Oxford (02-01-2023 to 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 21625.15 }, { "payer_name": "UHC - Adhoc", "plan_name": "UHC - Adhoc All Payer", "methodology": "case rate", "standard_charge_dollar": 26340.29 }, { "payer_name": "UHC - Adhoc", "plan_name": "UHC - Adhoc Oxford", "methodology": "case rate", "standard_charge_dollar": 22284.65 }, { "payer_name": "Wellcare", "plan_name": "Wellcare Insurance Exchange", "methodology": "case rate", "standard_charge_dollar": 25068.15, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "case rate", "standard_charge_dollar": 15217.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup Medicare", "methodology": "case rate", "standard_charge_dollar": 15217.1, "additional_payer_notes": "100.00% of Medicare Rates" } ] } ] }, { "description": "Hc Esophageal Motility Study, Manometry", "code_information": [ { "code": "91010", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 1982.6, "discounted_cash": 441.0, "minimum": 352.92, "maximum": 1982.6, "payers_information": [ { "payer_name": "UHC", "plan_name": "UHC Oxford (02-01-2023 to 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 1982.6 }, { "payer_name": "UHC - Adhoc", "plan_name": "UHC - Adhoc All Payer", "methodology": "case rate", "standard_charge_dollar": 1982.6 }, { "payer_name": "UHC - Adhoc", "plan_name": "UHC - Adhoc Oxford", "methodology": "case rate", "standard_charge_dollar": 1982.6 }, { "payer_name": "Wellcare", "plan_name": "Wellcare Insurance Exchange", "methodology": "fee schedule", "standard_charge_dollar": 595.55, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 441.15, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup Medicare", "methodology": "fee schedule", "standard_charge_dollar": 441.15, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 935.24, "additional_payer_notes": "212.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medical Rental Network", "methodology": "fee schedule", "standard_charge_dollar": 935.24, "additional_payer_notes": "212.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 441.15, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "ALLY-ALIGN (FKA SPARTAN PLAN NJ, INC.)", "plan_name": "ALLY-ALIGN (FKA SPARTAN PLAN NJ, INC.)", "methodology": "fee schedule", "standard_charge_dollar": 463.21, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Americhoice (UHC)", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 441.15, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Amerihealth", "plan_name": "Amerihealth Medicare", "methodology": "fee schedule", "standard_charge_dollar": 441.15, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 648.27, "additional_payer_notes": "146.95% of Medicare Rates" }, { "payer_name": "Clover Health", "plan_name": "Clover Medicare", "methodology": "fee schedule", "standard_charge_dollar": 441.15, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Coventry", "plan_name": "Coventry Auto", "methodology": "fee schedule", "standard_charge_dollar": 882.3, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Coventry", "plan_name": "Coventry Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 882.3, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "fee schedule", "standard_charge_dollar": 617.61, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Fairprice Healthcare Holdings", "plan_name": "Fairprice Healthcare Holdings", "methodology": "fee schedule", "standard_charge_dollar": 705.84, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ HMO POS", "methodology": "fee schedule", "standard_charge_dollar": 782.16, "additional_payer_notes": "177.30% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ Indemnity", "methodology": "fee schedule", "standard_charge_dollar": 782.16, "additional_payer_notes": "177.30% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ PPO", "methodology": "fee schedule", "standard_charge_dollar": 782.16, "additional_payer_notes": "177.30% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon Medicare", "methodology": "fee schedule", "standard_charge_dollar": 441.15, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Military Tricare", "methodology": "fee schedule", "standard_charge_dollar": 352.92, "additional_payer_notes": "80.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 441.15, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 441.15, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC All Payer (02-01-2023 to 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 1982.6 } ] } ] }, { "description": "ADRENAL AND PITUITARY PROCEDURES WITH CCMCC", "code_information": [ { "code": "614", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 26886.0, "minimum": 14759.11, "maximum": 48664.0039, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "case rate", "standard_charge_dollar": 48664.0, "additional_payer_notes": "181.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medical Rental Network", "methodology": "case rate", "standard_charge_dollar": 48664.0, "additional_payer_notes": "181.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "case rate", "standard_charge_dollar": 21895.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "ALLY-ALIGN (FKA SPARTAN PLAN NJ, INC.)", "plan_name": "ALLY-ALIGN (FKA SPARTAN PLAN NJ, INC.)", "methodology": "case rate", "standard_charge_dollar": 28230.5, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Americhoice (UHC)", "plan_name": "UHC Medicare", "methodology": "case rate", "standard_charge_dollar": 21895.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Amerihealth", "plan_name": "Amerihealth Medicare", "methodology": "case rate", "standard_charge_dollar": 21895.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Commercial", "methodology": "case rate", "standard_charge_dollar": 32066.03 }, { "payer_name": "Clover Health", "plan_name": "Clover Medicare", "methodology": "case rate", "standard_charge_dollar": 21895.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Coventry", "plan_name": "Coventry Auto", "methodology": "case rate", "standard_charge_dollar": 45706.52, "additional_payer_notes": "170.00% of Medicare Rates" }, { "payer_name": "Coventry", "plan_name": "Coventry Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 45706.52, "additional_payer_notes": "170.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "case rate", "standard_charge_dollar": 34952.05, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Fairprice Healthcare Holdings", "plan_name": "Fairprice Healthcare Holdings", "methodology": "case rate", "standard_charge_dollar": 43017.9, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon Medicare", "methodology": "case rate", "standard_charge_dollar": 21895.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon NJ Health Medicaid", "methodology": "case rate", "standard_charge_dollar": 14759.11 }, { "payer_name": "Humana", "plan_name": "Humana Military Tricare", "methodology": "case rate", "standard_charge_dollar": 21508.95, "additional_payer_notes": "80.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 26886.19, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 35634.3 }, { "payer_name": "UBH", "plan_name": "UBH Medicare", "methodology": "case rate", "standard_charge_dollar": 21895.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC All Payer (02-01-2023 to 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 36944.98 }, { "payer_name": "UHC", "plan_name": "UHC Oxford (02-01-2023 to 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 32197.54 }, { "payer_name": "UHC - Adhoc", "plan_name": "UHC - Adhoc All Payer", "methodology": "case rate", "standard_charge_dollar": 39217.88 }, { "payer_name": "UHC - Adhoc", "plan_name": "UHC - Adhoc Oxford", "methodology": "case rate", "standard_charge_dollar": 33179.47 }, { "payer_name": "Wellcare", "plan_name": "Wellcare Insurance Exchange", "methodology": "case rate", "standard_charge_dollar": 36296.36, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "case rate", "standard_charge_dollar": 21895.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup Medicare", "methodology": "case rate", "standard_charge_dollar": 21895.6, "additional_payer_notes": "100.00% of Medicare Rates" } ] } ] }, { "description": "Repair Of Hydrocele", "code_information": [ { "code": "55060", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 23085.0, "discounted_cash": 4167.0, "minimum": 1715.0, "maximum": 18468.0, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 8834.57, "additional_payer_notes": "212.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medical Rental Network", "methodology": "fee schedule", "standard_charge_dollar": 8834.57, "additional_payer_notes": "212.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 4167.25, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "ALLY-ALIGN (FKA SPARTAN PLAN NJ, INC.)", "plan_name": "ALLY-ALIGN (FKA SPARTAN PLAN NJ, INC.)", "methodology": "fee schedule", "standard_charge_dollar": 4375.61, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Americhoice (UHC)", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 4167.25, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Amerihealth", "plan_name": "Amerihealth Medicare", "methodology": "fee schedule", "standard_charge_dollar": 4167.25, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 6123.77, "additional_payer_notes": "146.95% of Medicare Rates" }, { "payer_name": "Clover Health", "plan_name": "Clover Medicare", "methodology": "fee schedule", "standard_charge_dollar": 4167.25, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Coventry", "plan_name": "Coventry Auto", "methodology": "fee schedule", "standard_charge_dollar": 8334.5, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Coventry", "plan_name": "Coventry Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 8334.5, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "fee schedule", "standard_charge_dollar": 5834.15, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Fairprice Healthcare Holdings", "plan_name": "Fairprice Healthcare Holdings", "methodology": "fee schedule", "standard_charge_dollar": 6667.6, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ HMO POS", "methodology": "fee schedule", "standard_charge_dollar": 7388.53, "additional_payer_notes": "177.30% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ Indemnity", "methodology": "fee schedule", "standard_charge_dollar": 7388.53, "additional_payer_notes": "177.30% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ PPO", "methodology": "fee schedule", "standard_charge_dollar": 7388.53, "additional_payer_notes": "177.30% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon Medicare", "methodology": "fee schedule", "standard_charge_dollar": 4167.25, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Military Tricare", "methodology": "fee schedule", "standard_charge_dollar": 3333.8, "additional_payer_notes": "80.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 4167.25, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 4167.25, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC All Payer (02-01-2023 to 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 4415.0 }, { "payer_name": "UHC", "plan_name": "UHC Oxford (02-01-2023 to 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 4020.0 }, { "payer_name": "UHC - Adhoc", "plan_name": "UHC - Adhoc All Payer", "methodology": "case rate", "standard_charge_dollar": 4687.0 }, { "payer_name": "UHC - Adhoc", "plan_name": "UHC - Adhoc Oxford", "methodology": "case rate", "standard_charge_dollar": 4143.0 }, { "payer_name": "Wellcare", "plan_name": "Wellcare Insurance Exchange", "methodology": "fee schedule", "standard_charge_dollar": 5625.79, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 4167.25, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellchoice", "plan_name": "WELLCHOICE HMO of NJ (Empire) Commercial (HMO / HMO POS, PPO)", "methodology": "case rate", "standard_charge_dollar": 1715.0 }, { "payer_name": "Wellchoice", "plan_name": "WELLCHOICE HMO of NJ (Empire) Commercial (Indemnity)", "methodology": "case rate", "standard_charge_dollar": 1978.0 }, { "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup Medicare", "methodology": "fee schedule", "standard_charge_dollar": 4167.25, "additional_payer_notes": "100.00% of Medicare Rates" } ] } ] }, { "description": "Hc Repr Wnd Intrmd Face >30.1 Cm", "code_information": [ { "code": "12057", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 1170.71, "discounted_cash": 480.0, "minimum": 223.4885, "maximum": 1170.71, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 1018.83, "additional_payer_notes": "212.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medical Rental Network", "methodology": "fee schedule", "standard_charge_dollar": 1018.83, "additional_payer_notes": "212.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 480.58, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "ALLY-ALIGN (FKA SPARTAN PLAN NJ, INC.)", "plan_name": "ALLY-ALIGN (FKA SPARTAN PLAN NJ, INC.)", "methodology": "fee schedule", "standard_charge_dollar": 504.61, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Americhoice (UHC)", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 480.58, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Amerihealth", "plan_name": "Amerihealth Medicare", "methodology": "fee schedule", "standard_charge_dollar": 480.58, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 706.21, "additional_payer_notes": "146.95% of Medicare Rates" }, { "payer_name": "Clover Health", "plan_name": "Clover Medicare", "methodology": "fee schedule", "standard_charge_dollar": 480.58, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Coventry", "plan_name": "Coventry Auto", "methodology": "fee schedule", "standard_charge_dollar": 961.16, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Coventry", "plan_name": "Coventry Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 961.16, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "fee schedule", "standard_charge_dollar": 672.81, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Fairprice Healthcare Holdings", "plan_name": "Fairprice Healthcare Holdings", "methodology": "fee schedule", "standard_charge_dollar": 768.93, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ HMO POS", "methodology": "fee schedule", "standard_charge_dollar": 852.07, "additional_payer_notes": "177.30% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ Indemnity", "methodology": "fee schedule", "standard_charge_dollar": 852.07, "additional_payer_notes": "177.30% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ PPO", "methodology": "fee schedule", "standard_charge_dollar": 852.07, "additional_payer_notes": "177.30% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon Medicare", "methodology": "fee schedule", "standard_charge_dollar": 480.58, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Military Tricare", "methodology": "fee schedule", "standard_charge_dollar": 384.46, "additional_payer_notes": "80.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 480.58, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 480.58, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC All Payer (02-01-2023 to 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 1170.71 }, { "payer_name": "UHC", "plan_name": "UHC Oxford (02-01-2023 to 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 1170.71 }, { "payer_name": "UHC - Adhoc", "plan_name": "UHC - Adhoc All Payer", "methodology": "case rate", "standard_charge_dollar": 1170.71 }, { "payer_name": "UHC - Adhoc", "plan_name": "UHC - Adhoc Oxford", "methodology": "case rate", "standard_charge_dollar": 1170.71 }, { "payer_name": "Wellcare", "plan_name": "Wellcare Insurance Exchange", "methodology": "fee schedule", "standard_charge_dollar": 648.78, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 480.58, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellchoice", "plan_name": "WELLCHOICE HMO of NJ (Empire) Commercial (HMO / HMO POS, PPO)", "methodology": "case rate", "standard_charge_dollar": 1170.71 }, { "payer_name": "Wellchoice", "plan_name": "WELLCHOICE HMO of NJ (Empire) Commercial (Indemnity)", "methodology": "case rate", "standard_charge_dollar": 1170.71 }, { "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup Medicare", "methodology": "fee schedule", "standard_charge_dollar": 480.58, "additional_payer_notes": "100.00% of Medicare Rates" } ] } ] }, { "description": "MAJOR GASTROINTESTINAL & PERITONEAL INFECTIONS - SOI : 3", "code_information": [ { "code": "2483", "type": "APR-DRG" } ], "standard_charges": [ { "setting": "inpatient", "minimum": 12811.66, "maximum": 14092.82, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Better Health - Medi Medi", "methodology": "case rate", "standard_charge_dollar": 14092.82, "additional_payer_notes": "110% of State Medicaid Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Better Health Medicaid", "methodology": "case rate", "standard_charge_dollar": 14092.82, "additional_payer_notes": "110% of State Medicaid Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "case rate", "standard_charge_dollar": 12811.66, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "UBH", "plan_name": "UBH Medicaid", "methodology": "case rate", "standard_charge_dollar": 12811.66, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicaid (02/01/2023 to 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 13067.89, "additional_payer_notes": "102% of State Medicaid Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicaid", "methodology": "case rate", "standard_charge_dollar": 12811.66, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup Medicaid", "methodology": "case rate", "standard_charge_dollar": 12811.66, "additional_payer_notes": "100% of State Medicaid Rates" } ] } ] }, { "description": "CHEMOTHERAPY WITHOUT ACUTE LEUKEMIA AS SECONDARY DIAGNOSIS WITHOUT CCMCC", "code_information": [ { "code": "848", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 11372.0, "minimum": 5823.47, "maximum": 20584.7499, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "case rate", "standard_charge_dollar": 20584.75, "additional_payer_notes": "181.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medical Rental Network", "methodology": "case rate", "standard_charge_dollar": 20584.75, "additional_payer_notes": "181.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "case rate", "standard_charge_dollar": 9438.75, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "ALLY-ALIGN (FKA SPARTAN PLAN NJ, INC.)", "plan_name": "ALLY-ALIGN (FKA SPARTAN PLAN NJ, INC.)", "methodology": "case rate", "standard_charge_dollar": 11941.43, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Americhoice (UHC)", "plan_name": "UHC Medicare", "methodology": "case rate", "standard_charge_dollar": 9438.75, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Amerihealth", "plan_name": "Amerihealth Medicare", "methodology": "case rate", "standard_charge_dollar": 9438.75, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Commercial", "methodology": "case rate", "standard_charge_dollar": 12426.72 }, { "payer_name": "Clover Health", "plan_name": "Clover Medicare", "methodology": "case rate", "standard_charge_dollar": 9438.75, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Coventry", "plan_name": "Coventry Auto", "methodology": "case rate", "standard_charge_dollar": 19333.74, "additional_payer_notes": "170.00% of Medicare Rates" }, { "payer_name": "Coventry", "plan_name": "Coventry Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 19333.74, "additional_payer_notes": "170.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "case rate", "standard_charge_dollar": 14784.63, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Fairprice Healthcare Holdings", "plan_name": "Fairprice Healthcare Holdings", "methodology": "case rate", "standard_charge_dollar": 18196.46, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon Medicare", "methodology": "case rate", "standard_charge_dollar": 9438.75, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon NJ Health Medicaid", "methodology": "case rate", "standard_charge_dollar": 5823.47 }, { "payer_name": "Humana", "plan_name": "Humana Military Tricare", "methodology": "case rate", "standard_charge_dollar": 9098.23, "additional_payer_notes": "80.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 11372.79, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 9552.46 }, { "payer_name": "UBH", "plan_name": "UBH Medicare", "methodology": "case rate", "standard_charge_dollar": 9438.75, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC All Payer (02-01-2023 to 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 14317.49 }, { "payer_name": "UHC", "plan_name": "UHC Oxford (02-01-2023 to 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 12477.69 }, { "payer_name": "UHC - Adhoc", "plan_name": "UHC - Adhoc All Payer", "methodology": "case rate", "standard_charge_dollar": 15198.31 }, { "payer_name": "UHC - Adhoc", "plan_name": "UHC - Adhoc Oxford", "methodology": "case rate", "standard_charge_dollar": 12858.22 }, { "payer_name": "Wellcare", "plan_name": "Wellcare Insurance Exchange", "methodology": "case rate", "standard_charge_dollar": 15353.27, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "case rate", "standard_charge_dollar": 9438.75, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup Medicare", "methodology": "case rate", "standard_charge_dollar": 9438.75, "additional_payer_notes": "100.00% of Medicare Rates" } ] } ] }, { "description": "Exc Bartholins Gland/Cyst", "code_information": [ { "code": "56740", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 15725.1, "discounted_cash": 3826.0, "minimum": 1328.2402, "maximum": 12580.08, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 8113.13, "additional_payer_notes": "212.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medical Rental Network", "methodology": "fee schedule", "standard_charge_dollar": 8113.13, "additional_payer_notes": "212.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3826.95, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "ALLY-ALIGN (FKA SPARTAN PLAN NJ, INC.)", "plan_name": "ALLY-ALIGN (FKA SPARTAN PLAN NJ, INC.)", "methodology": "fee schedule", "standard_charge_dollar": 4018.3, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Americhoice (UHC)", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3826.95, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Amerihealth", "plan_name": "Amerihealth Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3826.95, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 5623.7, "additional_payer_notes": "146.95% of Medicare Rates" }, { "payer_name": "Clover Health", "plan_name": "Clover Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3826.95, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Coventry", "plan_name": "Coventry Auto", "methodology": "fee schedule", "standard_charge_dollar": 7653.9, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Coventry", "plan_name": "Coventry Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 7653.9, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "fee schedule", "standard_charge_dollar": 5357.73, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Fairprice Healthcare Holdings", "plan_name": "Fairprice Healthcare Holdings", "methodology": "fee schedule", "standard_charge_dollar": 6123.12, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ HMO POS", "methodology": "fee schedule", "standard_charge_dollar": 6785.18, "additional_payer_notes": "177.30% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ Indemnity", "methodology": "fee schedule", "standard_charge_dollar": 6785.18, "additional_payer_notes": "177.30% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ PPO", "methodology": "fee schedule", "standard_charge_dollar": 6785.18, "additional_payer_notes": "177.30% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3826.95, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon NJ Health Medicaid", "methodology": "percent of total billed charges", "standard_charge_percentage": 19.58, "median_amount": 2008.91, "10th_percentile": 2008.91, "90th_percentile": 2677.37, "count": "1 through 10" }, { "payer_name": "Humana", "plan_name": "Humana Military Tricare", "methodology": "fee schedule", "standard_charge_dollar": 3061.56, "additional_payer_notes": "80.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3826.95, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 3826.95, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC All Payer (02-01-2023 to 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 4415.0 }, { "payer_name": "UHC", "plan_name": "UHC Medicaid (02/01/2023 to 12-31-2026)", "methodology": "percent of total billed charges", "standard_charge_percentage": 19.47, "median_amount": 609.93, "10th_percentile": 609.93, "90th_percentile": 2601.2, "count": "1 through 10" }, { "payer_name": "UHC", "plan_name": "UHC Oxford (02-01-2023 to 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 4020.0 }, { "payer_name": "UHC - Adhoc", "plan_name": "UHC - Adhoc All Payer", "methodology": "case rate", "standard_charge_dollar": 4687.0 }, { "payer_name": "UHC - Adhoc", "plan_name": "UHC - Adhoc Oxford", "methodology": "case rate", "standard_charge_dollar": 4143.0 }, { "payer_name": "Wellcare", "plan_name": "Wellcare Insurance Exchange", "methodology": "fee schedule", "standard_charge_dollar": 5166.38, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3826.95, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellchoice", "plan_name": "WELLCHOICE HMO of NJ (Empire) Commercial (HMO / HMO POS, PPO)", "methodology": "case rate", "standard_charge_dollar": 1715.0 }, { "payer_name": "Wellchoice", "plan_name": "WELLCHOICE HMO of NJ (Empire) Commercial (Indemnity)", "methodology": "case rate", "standard_charge_dollar": 1978.0 }, { "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3826.95, "additional_payer_notes": "100.00% of Medicare Rates" } ] } ] }, { "description": "Corneal transplant - 65755 - ", "code_information": [ { "code": "65755", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 25965.0, "discounted_cash": 4886.0, "minimum": 1715.0, "maximum": 20772.0, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 10359.49, "additional_payer_notes": "212.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medical Rental Network", "methodology": "fee schedule", "standard_charge_dollar": 10359.49, "additional_payer_notes": "212.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 4886.55, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "ALLY-ALIGN (FKA SPARTAN PLAN NJ, INC.)", "plan_name": "ALLY-ALIGN (FKA SPARTAN PLAN NJ, INC.)", "methodology": "fee schedule", "standard_charge_dollar": 5130.88, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Americhoice (UHC)", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 4886.55, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Amerihealth", "plan_name": "Amerihealth Medicare", "methodology": "fee schedule", "standard_charge_dollar": 4886.55, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 7180.79, "additional_payer_notes": "146.95% of Medicare Rates" }, { "payer_name": "Clover Health", "plan_name": "Clover Medicare", "methodology": "fee schedule", "standard_charge_dollar": 4886.55, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Coventry", "plan_name": "Coventry Auto", "methodology": "fee schedule", "standard_charge_dollar": 9773.1, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Coventry", "plan_name": "Coventry Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 9773.1, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "fee schedule", "standard_charge_dollar": 6841.17, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Fairprice Healthcare Holdings", "plan_name": "Fairprice Healthcare Holdings", "methodology": "fee schedule", "standard_charge_dollar": 7818.48, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ HMO POS", "methodology": "fee schedule", "standard_charge_dollar": 8663.85, "additional_payer_notes": "177.30% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ Indemnity", "methodology": "fee schedule", "standard_charge_dollar": 8663.85, "additional_payer_notes": "177.30% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ PPO", "methodology": "fee schedule", "standard_charge_dollar": 8663.85, "additional_payer_notes": "177.30% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon Medicare", "methodology": "fee schedule", "standard_charge_dollar": 4886.55, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Military Tricare", "methodology": "fee schedule", "standard_charge_dollar": 3909.24, "additional_payer_notes": "80.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 4886.55, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 4886.55, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC All Payer (02-01-2023 to 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 5667.0 }, { "payer_name": "UHC", "plan_name": "UHC Oxford (02-01-2023 to 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 5169.0 }, { "payer_name": "UHC - Adhoc", "plan_name": "UHC - Adhoc All Payer", "methodology": "case rate", "standard_charge_dollar": 6016.0 }, { "payer_name": "UHC - Adhoc", "plan_name": "UHC - Adhoc Oxford", "methodology": "case rate", "standard_charge_dollar": 5327.0 }, { "payer_name": "Wellcare", "plan_name": "Wellcare Insurance Exchange", "methodology": "fee schedule", "standard_charge_dollar": 6596.84, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 4886.55, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellchoice", "plan_name": "WELLCHOICE HMO of NJ (Empire) Commercial (HMO / HMO POS, PPO)", "methodology": "case rate", "standard_charge_dollar": 1715.0 }, { "payer_name": "Wellchoice", "plan_name": "WELLCHOICE HMO of NJ (Empire) Commercial (Indemnity)", "methodology": "case rate", "standard_charge_dollar": 1978.0 }, { "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup Medicare", "methodology": "fee schedule", "standard_charge_dollar": 4886.55, "additional_payer_notes": "100.00% of Medicare Rates" } ] } ] }, { "description": "ADRENAL PROCEDURES - SOI : 4", "code_information": [ { "code": "4014", "type": "APR-DRG" } ], "standard_charges": [ { "setting": "inpatient", "minimum": 61769.0, "maximum": 67945.9, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Better Health - Medi Medi", "methodology": "case rate", "standard_charge_dollar": 67945.9, "additional_payer_notes": "110% of State Medicaid Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Better Health Medicaid", "methodology": "case rate", "standard_charge_dollar": 67945.9, "additional_payer_notes": "110% of State Medicaid Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "case rate", "standard_charge_dollar": 61769.0, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "UBH", "plan_name": "UBH Medicaid", "methodology": "case rate", "standard_charge_dollar": 61769.0, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicaid (02/01/2023 to 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 63004.38, "additional_payer_notes": "102% of State Medicaid Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicaid", "methodology": "case rate", "standard_charge_dollar": 61769.0, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup Medicaid", "methodology": "case rate", "standard_charge_dollar": 61769.0, "additional_payer_notes": "100% of State Medicaid Rates" } ] } ] }, { "description": "Hc Remove Foreign Body Complex", "code_information": [ { "code": "10121", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 4379.25, "discounted_cash": 1952.0, "minimum": 835.9988, "maximum": 4153.0, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 4139.36, "additional_payer_notes": "212.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medical Rental Network", "methodology": "fee schedule", "standard_charge_dollar": 4139.36, "additional_payer_notes": "212.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1952.53, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "ALLY-ALIGN (FKA SPARTAN PLAN NJ, INC.)", "plan_name": "ALLY-ALIGN (FKA SPARTAN PLAN NJ, INC.)", "methodology": "fee schedule", "standard_charge_dollar": 2050.16, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Americhoice (UHC)", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1952.53, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Amerihealth", "plan_name": "Amerihealth Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1952.53, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 2869.24, "additional_payer_notes": "146.95% of Medicare Rates" }, { "payer_name": "Clover Health", "plan_name": "Clover Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1952.53, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Coventry", "plan_name": "Coventry Auto", "methodology": "fee schedule", "standard_charge_dollar": 3905.06, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Coventry", "plan_name": "Coventry Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 3905.06, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "fee schedule", "standard_charge_dollar": 2733.54, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Fairprice Healthcare Holdings", "plan_name": "Fairprice Healthcare Holdings", "methodology": "fee schedule", "standard_charge_dollar": 3124.05, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ HMO POS", "methodology": "fee schedule", "standard_charge_dollar": 3461.84, "additional_payer_notes": "177.30% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ Indemnity", "methodology": "fee schedule", "standard_charge_dollar": 3461.84, "additional_payer_notes": "177.30% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ PPO", "methodology": "fee schedule", "standard_charge_dollar": 3461.84, "additional_payer_notes": "177.30% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1952.53, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Military Tricare", "methodology": "fee schedule", "standard_charge_dollar": 1562.02, "additional_payer_notes": "80.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1952.53, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 1952.53, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC All Payer (02-01-2023 to 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 3912.0 }, { "payer_name": "UHC", "plan_name": "UHC Oxford (02-01-2023 to 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 3676.0 }, { "payer_name": "UHC - Adhoc", "plan_name": "UHC - Adhoc All Payer", "methodology": "case rate", "standard_charge_dollar": 4153.0 }, { "payer_name": "UHC - Adhoc", "plan_name": "UHC - Adhoc Oxford", "methodology": "case rate", "standard_charge_dollar": 3788.0 }, { "payer_name": "Wellcare", "plan_name": "Wellcare Insurance Exchange", "methodology": "fee schedule", "standard_charge_dollar": 2635.92, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1952.53, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellchoice", "plan_name": "WELLCHOICE HMO of NJ (Empire) Commercial (HMO / HMO POS, PPO)", "methodology": "case rate", "standard_charge_dollar": 1715.0 }, { "payer_name": "Wellchoice", "plan_name": "WELLCHOICE HMO of NJ (Empire) Commercial (Indemnity)", "methodology": "case rate", "standard_charge_dollar": 1978.0 }, { "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1952.53, "additional_payer_notes": "100.00% of Medicare Rates" } ] } ] }, { "description": "Hc Blood Typing, Patient Serum", "code_information": [ { "code": "86904", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 45.77, "discounted_cash": 69.0, "minimum": 8.7375, "maximum": 45.77, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 45.77, "additional_payer_notes": "212.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medical Rental Network", "methodology": "fee schedule", "standard_charge_dollar": 45.77, "additional_payer_notes": "212.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 45.77, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "ALLY-ALIGN (FKA SPARTAN PLAN NJ, INC.)", "plan_name": "ALLY-ALIGN (FKA SPARTAN PLAN NJ, INC.)", "methodology": "fee schedule", "standard_charge_dollar": 45.77, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Americhoice (UHC)", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 45.77, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Amerihealth", "plan_name": "Amerihealth Medicare", "methodology": "fee schedule", "standard_charge_dollar": 45.77, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 45.77, "additional_payer_notes": "Laboratory - 145.00% of Medicare Rates" }, { "payer_name": "Clover Health", "plan_name": "Clover Medicare", "methodology": "fee schedule", "standard_charge_dollar": 45.77, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Coventry", "plan_name": "Coventry Auto", "methodology": "fee schedule", "standard_charge_dollar": 45.77, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Coventry", "plan_name": "Coventry Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 45.77, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "fee schedule", "standard_charge_dollar": 45.77, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Fairprice Healthcare Holdings", "plan_name": "Fairprice Healthcare Holdings", "methodology": "fee schedule", "standard_charge_dollar": 45.77, "additional_payer_notes": "Laboratory - 120.00% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ HMO POS", "methodology": "fee schedule", "standard_charge_dollar": 45.77, "additional_payer_notes": "177.30% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ Indemnity", "methodology": "fee schedule", "standard_charge_dollar": 45.77, "additional_payer_notes": "177.30% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ PPO", "methodology": "fee schedule", "standard_charge_dollar": 45.77, "additional_payer_notes": "177.30% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon Medicare", "methodology": "fee schedule", "standard_charge_dollar": 45.77, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Military Tricare", "methodology": "fee schedule", "standard_charge_dollar": 45.77, "additional_payer_notes": "80.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 45.77, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 45.77, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC All Payer (02-01-2023 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 9.8 }, { "payer_name": "UHC", "plan_name": "UHC Medicaid (02/01/2023 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 11.7 }, { "payer_name": "UHC", "plan_name": "UHC Oxford (02-01-2023 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 9.8 }, { "payer_name": "UHC - Adhoc", "plan_name": "UHC - Adhoc All Payer", "methodology": "fee schedule", "standard_charge_dollar": 16.34 }, { "payer_name": "UHC - Adhoc", "plan_name": "UHC - Adhoc Oxford", "methodology": "fee schedule", "standard_charge_dollar": 16.34 }, { "payer_name": "Wellcare", "plan_name": "Wellcare Insurance Exchange", "methodology": "fee schedule", "standard_charge_dollar": 45.77, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 45.77, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup Medicare", "methodology": "fee schedule", "standard_charge_dollar": 45.77, "additional_payer_notes": "100.00% of Medicare Rates" } ] } ] }, { "description": "Hc Tissue Culture, Placenta", "code_information": [ { "code": "88235", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 408.0, "discounted_cash": 150.0, "minimum": 77.8872, "maximum": 346.8, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 318.64, "additional_payer_notes": "212.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medical Rental Network", "methodology": "fee schedule", "standard_charge_dollar": 318.64, "additional_payer_notes": "212.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 150.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "ALLY-ALIGN (FKA SPARTAN PLAN NJ, INC.)", "plan_name": "ALLY-ALIGN (FKA SPARTAN PLAN NJ, INC.)", "methodology": "fee schedule", "standard_charge_dollar": 157.82, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Americhoice (UHC)", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 150.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Amerihealth", "plan_name": "Amerihealth Medicare", "methodology": "fee schedule", "standard_charge_dollar": 150.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 217.94, "additional_payer_notes": "Laboratory - 145.00% of Medicare Rates" }, { "payer_name": "Clover Health", "plan_name": "Clover Medicare", "methodology": "fee schedule", "standard_charge_dollar": 150.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Coventry", "plan_name": "Coventry Auto", "methodology": "fee schedule", "standard_charge_dollar": 300.6, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Coventry", "plan_name": "Coventry Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 300.6, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "fee schedule", "standard_charge_dollar": 210.42, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Fairprice Healthcare Holdings", "plan_name": "Fairprice Healthcare Holdings", "methodology": "fee schedule", "standard_charge_dollar": 180.36, "additional_payer_notes": "Laboratory - 120.00% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ HMO POS", "methodology": "fee schedule", "standard_charge_dollar": 288.05, "additional_payer_notes": "177.30% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ Indemnity", "methodology": "fee schedule", "standard_charge_dollar": 288.05, "additional_payer_notes": "177.30% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ PPO", "methodology": "fee schedule", "standard_charge_dollar": 288.05, "additional_payer_notes": "177.30% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon Medicare", "methodology": "fee schedule", "standard_charge_dollar": 150.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon NJ Health Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 120.24 }, { "payer_name": "Humana", "plan_name": "Humana Military Tricare", "methodology": "fee schedule", "standard_charge_dollar": 120.24, "additional_payer_notes": "80.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 150.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 150.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC All Payer (02-01-2023 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 90.18 }, { "payer_name": "UHC", "plan_name": "UHC Medicaid (02/01/2023 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 120.24 }, { "payer_name": "UHC", "plan_name": "UHC Oxford (02-01-2023 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 90.18 }, { "payer_name": "UHC - Adhoc", "plan_name": "UHC - Adhoc All Payer", "methodology": "fee schedule", "standard_charge_dollar": 150.3 }, { "payer_name": "UHC - Adhoc", "plan_name": "UHC - Adhoc Oxford", "methodology": "fee schedule", "standard_charge_dollar": 150.3 }, { "payer_name": "Wellcare", "plan_name": "Wellcare Insurance Exchange", "methodology": "fee schedule", "standard_charge_dollar": 202.91, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 150.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup Medicare", "methodology": "fee schedule", "standard_charge_dollar": 150.3, "additional_payer_notes": "100.00% of Medicare Rates" } ] } ] }, { "description": "VAGINAL DELIVERY - SOI : 2", "code_information": [ { "code": "5602", "type": "APR-DRG" } ], "standard_charges": [ { "setting": "inpatient", "minimum": 5031.11, "maximum": 5534.22, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Better Health - Medi Medi", "methodology": "case rate", "standard_charge_dollar": 5534.22, "additional_payer_notes": "110% of State Medicaid Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Better Health Medicaid", "methodology": "case rate", "standard_charge_dollar": 5534.22, "additional_payer_notes": "110% of State Medicaid Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "case rate", "standard_charge_dollar": 5031.11, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "UBH", "plan_name": "UBH Medicaid", "methodology": "case rate", "standard_charge_dollar": 5031.11, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicaid (02/01/2023 to 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 5131.73, "additional_payer_notes": "102% of State Medicaid Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicaid", "methodology": "case rate", "standard_charge_dollar": 5031.11, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup Medicaid", "methodology": "case rate", "standard_charge_dollar": 5031.11, "additional_payer_notes": "100% of State Medicaid Rates" } ] } ] }, { "description": "Hc Prq Drug Eluting Cor Revasc T Cabg S - C9604 - 48100196", "code_information": [ { "code": "C9604", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 48345.2, "discounted_cash": 13647.0, "minimum": 2472.0, "maximum": 45362.24, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 28932.91, "additional_payer_notes": "212.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medical Rental Network", "methodology": "fee schedule", "standard_charge_dollar": 28932.91, "additional_payer_notes": "212.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 13647.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "ALLY-ALIGN (FKA SPARTAN PLAN NJ, INC.)", "plan_name": "ALLY-ALIGN (FKA SPARTAN PLAN NJ, INC.)", "methodology": "fee schedule", "standard_charge_dollar": 14329.98, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Americhoice (UHC)", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 13647.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Amerihealth", "plan_name": "Amerihealth Medicare", "methodology": "fee schedule", "standard_charge_dollar": 13647.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 20055.15, "additional_payer_notes": "146.95% of Medicare Rates" }, { "payer_name": "Clover Health", "plan_name": "Clover Medicare", "methodology": "fee schedule", "standard_charge_dollar": 13647.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Coventry", "plan_name": "Coventry Auto", "methodology": "fee schedule", "standard_charge_dollar": 27295.2, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Coventry", "plan_name": "Coventry Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 27295.2, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "fee schedule", "standard_charge_dollar": 19106.64, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Fairprice Healthcare Holdings", "plan_name": "Fairprice Healthcare Holdings", "methodology": "fee schedule", "standard_charge_dollar": 21836.16, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ HMO POS", "methodology": "fee schedule", "standard_charge_dollar": 24197.19, "additional_payer_notes": "177.30% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ Indemnity", "methodology": "fee schedule", "standard_charge_dollar": 24197.19, "additional_payer_notes": "177.30% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ PPO", "methodology": "fee schedule", "standard_charge_dollar": 24197.19, "additional_payer_notes": "177.30% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon Medicare", "methodology": "fee schedule", "standard_charge_dollar": 13647.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon NJ Health Medicaid", "methodology": "percent of total billed charges", "standard_charge_percentage": 19.58, "median_amount": 11102.42, "10th_percentile": 11102.42, "90th_percentile": 11102.42, "count": "1 through 10" }, { "payer_name": "Humana", "plan_name": "Humana Military Tricare", "methodology": "fee schedule", "standard_charge_dollar": 10918.08, "additional_payer_notes": "80.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 13647.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 13647.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC All Payer (02-01-2023 to 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 7566.0 }, { "payer_name": "UHC", "plan_name": "UHC Oxford (02-01-2023 to 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 6317.0 }, { "payer_name": "UHC - Adhoc", "plan_name": "UHC - Adhoc All Payer", "methodology": "case rate", "standard_charge_dollar": 8031.0 }, { "payer_name": "UHC - Adhoc", "plan_name": "UHC - Adhoc Oxford", "methodology": "case rate", "standard_charge_dollar": 6510.0 }, { "payer_name": "Wellcare", "plan_name": "Wellcare Insurance Exchange", "methodology": "fee schedule", "standard_charge_dollar": 18424.26, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 13647.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellchoice", "plan_name": "WELLCHOICE HMO of NJ (Empire) Commercial (HMO / HMO POS, PPO)", "methodology": "case rate", "standard_charge_dollar": 2472.0 }, { "payer_name": "Wellchoice", "plan_name": "WELLCHOICE HMO of NJ (Empire) Commercial (Indemnity)", "methodology": "case rate", "standard_charge_dollar": 2753.0 }, { "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup Medicare", "methodology": "fee schedule", "standard_charge_dollar": 13647.6, "additional_payer_notes": "100.00% of Medicare Rates" } ] } ] }, { "description": "OTHER ESOPHAGEAL DISORDERS - SOI : 2", "code_information": [ { "code": "2432", "type": "APR-DRG" } ], "standard_charges": [ { "setting": "inpatient", "minimum": 8445.71, "maximum": 9290.28, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Better Health - Medi Medi", "methodology": "case rate", "standard_charge_dollar": 9290.28, "additional_payer_notes": "110% of State Medicaid Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Better Health Medicaid", "methodology": "case rate", "standard_charge_dollar": 9290.28, "additional_payer_notes": "110% of State Medicaid Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "case rate", "standard_charge_dollar": 8445.71, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "UBH", "plan_name": "UBH Medicaid", "methodology": "case rate", "standard_charge_dollar": 8445.71, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicaid (02/01/2023 to 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 8614.63, "additional_payer_notes": "102% of State Medicaid Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicaid", "methodology": "case rate", "standard_charge_dollar": 8445.71, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup Medicaid", "methodology": "case rate", "standard_charge_dollar": 8445.71, "additional_payer_notes": "100% of State Medicaid Rates" } ] } ] }, { "description": "Hc Tracheotomy Er Cricothroid Membrane", "code_information": [ { "code": "31605", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 768.37, "discounted_cash": 280.0, "minimum": 146.6818, "maximum": 768.37, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 593.6, "additional_payer_notes": "212.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medical Rental Network", "methodology": "fee schedule", "standard_charge_dollar": 593.6, "additional_payer_notes": "212.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 280.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "ALLY-ALIGN (FKA SPARTAN PLAN NJ, INC.)", "plan_name": "ALLY-ALIGN (FKA SPARTAN PLAN NJ, INC.)", "methodology": "fee schedule", "standard_charge_dollar": 294.0, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Americhoice (UHC)", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 280.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Amerihealth", "plan_name": "Amerihealth Medicare", "methodology": "fee schedule", "standard_charge_dollar": 280.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 411.46, "additional_payer_notes": "146.95% of Medicare Rates" }, { "payer_name": "Clover Health", "plan_name": "Clover Medicare", "methodology": "fee schedule", "standard_charge_dollar": 280.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Coventry", "plan_name": "Coventry Auto", "methodology": "fee schedule", "standard_charge_dollar": 560.0, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Coventry", "plan_name": "Coventry Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 560.0, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "fee schedule", "standard_charge_dollar": 392.0, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Fairprice Healthcare Holdings", "plan_name": "Fairprice Healthcare Holdings", "methodology": "fee schedule", "standard_charge_dollar": 448.0, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ HMO POS", "methodology": "fee schedule", "standard_charge_dollar": 496.44, "additional_payer_notes": "177.30% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ Indemnity", "methodology": "fee schedule", "standard_charge_dollar": 496.44, "additional_payer_notes": "177.30% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ PPO", "methodology": "fee schedule", "standard_charge_dollar": 496.44, "additional_payer_notes": "177.30% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon Medicare", "methodology": "fee schedule", "standard_charge_dollar": 280.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Military Tricare", "methodology": "fee schedule", "standard_charge_dollar": 224.0, "additional_payer_notes": "80.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 280.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 280.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC All Payer (02-01-2023 to 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 768.37 }, { "payer_name": "UHC", "plan_name": "UHC Oxford (02-01-2023 to 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 768.37 }, { "payer_name": "UHC - Adhoc", "plan_name": "UHC - Adhoc All Payer", "methodology": "case rate", "standard_charge_dollar": 768.37 }, { "payer_name": "UHC - Adhoc", "plan_name": "UHC - Adhoc Oxford", "methodology": "case rate", "standard_charge_dollar": 768.37 }, { "payer_name": "Wellcare", "plan_name": "Wellcare Insurance Exchange", "methodology": "fee schedule", "standard_charge_dollar": 378.0, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 280.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellchoice", "plan_name": "WELLCHOICE HMO of NJ (Empire) Commercial (HMO / HMO POS, PPO)", "methodology": "case rate", "standard_charge_dollar": 768.37 }, { "payer_name": "Wellchoice", "plan_name": "WELLCHOICE HMO of NJ (Empire) Commercial (Indemnity)", "methodology": "case rate", "standard_charge_dollar": 768.37 }, { "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup Medicare", "methodology": "fee schedule", "standard_charge_dollar": 280.0, "additional_payer_notes": "100.00% of Medicare Rates" } ] } ] }, { "description": "IMPLANTABLE HEART ASSIST SYSTEMS- SOI : 3", "code_information": [ { "code": "1613", "type": "APR-DRG" } ], "standard_charges": [ { "setting": "inpatient", "minimum": 233260.3, "maximum": 256586.32, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Better Health - Medi Medi", "methodology": "case rate", "standard_charge_dollar": 256586.32, "additional_payer_notes": "110% of State Medicaid Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Better Health Medicaid", "methodology": "case rate", "standard_charge_dollar": 256586.32, "additional_payer_notes": "110% of State Medicaid Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "case rate", "standard_charge_dollar": 233260.3, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "UBH", "plan_name": "UBH Medicaid", "methodology": "case rate", "standard_charge_dollar": 233260.3, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicaid (02/01/2023 to 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 237925.5, "additional_payer_notes": "102% of State Medicaid Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicaid", "methodology": "case rate", "standard_charge_dollar": 233260.3, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup Medicaid", "methodology": "case rate", "standard_charge_dollar": 233260.3, "additional_payer_notes": "100% of State Medicaid Rates" } ] } ] }, { "description": "AMPUTATION OF LOWER LIMB FOR ENDOCRINE, NUTRITIONAL AND METABOLIC DISORDERS WITHOUT CCMCC", "code_information": [ { "code": "618", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 17947.0, "minimum": 7239.06, "maximum": 32484.5406, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "case rate", "standard_charge_dollar": 32484.54, "additional_payer_notes": "181.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medical Rental Network", "methodology": "case rate", "standard_charge_dollar": 32484.54, "additional_payer_notes": "181.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "case rate", "standard_charge_dollar": 14717.9, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "ALLY-ALIGN (FKA SPARTAN PLAN NJ, INC.)", "plan_name": "ALLY-ALIGN (FKA SPARTAN PLAN NJ, INC.)", "methodology": "case rate", "standard_charge_dollar": 18844.62, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Americhoice (UHC)", "plan_name": "UHC Medicare", "methodology": "case rate", "standard_charge_dollar": 14717.9, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Amerihealth", "plan_name": "Amerihealth Medicare", "methodology": "case rate", "standard_charge_dollar": 14717.9, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Commercial", "methodology": "case rate", "standard_charge_dollar": 20749.73 }, { "payer_name": "Clover Health", "plan_name": "Clover Medicare", "methodology": "case rate", "standard_charge_dollar": 14717.9, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Coventry", "plan_name": "Coventry Auto", "methodology": "case rate", "standard_charge_dollar": 30510.34, "additional_payer_notes": "170.00% of Medicare Rates" }, { "payer_name": "Coventry", "plan_name": "Coventry Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 30510.34, "additional_payer_notes": "170.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "case rate", "standard_charge_dollar": 23331.44, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Fairprice Healthcare Holdings", "plan_name": "Fairprice Healthcare Holdings", "methodology": "case rate", "standard_charge_dollar": 28715.62, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon Medicare", "methodology": "case rate", "standard_charge_dollar": 14717.9, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon NJ Health Medicaid", "methodology": "case rate", "standard_charge_dollar": 7239.06 }, { "payer_name": "Humana", "plan_name": "Humana Military Tricare", "methodology": "case rate", "standard_charge_dollar": 14357.81, "additional_payer_notes": "80.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 17947.26, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 18115.3 }, { "payer_name": "UBH", "plan_name": "UBH Medicare", "methodology": "case rate", "standard_charge_dollar": 14717.9, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC All Payer (02-01-2023 to 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 23906.86 }, { "payer_name": "UHC", "plan_name": "UHC Oxford (02-01-2023 to 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 20834.83 }, { "payer_name": "UHC - Adhoc", "plan_name": "UHC - Adhoc All Payer", "methodology": "case rate", "standard_charge_dollar": 25377.64 }, { "payer_name": "UHC - Adhoc", "plan_name": "UHC - Adhoc Oxford", "methodology": "case rate", "standard_charge_dollar": 21470.23 }, { "payer_name": "Wellcare", "plan_name": "Wellcare Insurance Exchange", "methodology": "case rate", "standard_charge_dollar": 24228.8, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "case rate", "standard_charge_dollar": 14717.9, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup Medicare", "methodology": "case rate", "standard_charge_dollar": 14717.9, "additional_payer_notes": "100.00% of Medicare Rates" } ] } ] }, { "description": "MALIGNANCY OF HEPATOBILIARY SYSTEM OR PANCREAS WITHOUT CCMCC", "code_information": [ { "code": "437", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 11417.0, "minimum": 5406.34, "maximum": 20666.3266, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "case rate", "standard_charge_dollar": 20666.33, "additional_payer_notes": "181.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medical Rental Network", "methodology": "case rate", "standard_charge_dollar": 20666.33, "additional_payer_notes": "181.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "case rate", "standard_charge_dollar": 9474.94, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "ALLY-ALIGN (FKA SPARTAN PLAN NJ, INC.)", "plan_name": "ALLY-ALIGN (FKA SPARTAN PLAN NJ, INC.)", "methodology": "case rate", "standard_charge_dollar": 11988.75, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Americhoice (UHC)", "plan_name": "UHC Medicare", "methodology": "case rate", "standard_charge_dollar": 9474.94, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Amerihealth", "plan_name": "Amerihealth Medicare", "methodology": "case rate", "standard_charge_dollar": 9474.94, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Commercial", "methodology": "case rate", "standard_charge_dollar": 12483.78 }, { "payer_name": "Clover Health", "plan_name": "Clover Medicare", "methodology": "case rate", "standard_charge_dollar": 9474.94, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Coventry", "plan_name": "Coventry Auto", "methodology": "case rate", "standard_charge_dollar": 19410.36, "additional_payer_notes": "170.00% of Medicare Rates" }, { "payer_name": "Coventry", "plan_name": "Coventry Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 19410.36, "additional_payer_notes": "170.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "case rate", "standard_charge_dollar": 14843.22, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Fairprice Healthcare Holdings", "plan_name": "Fairprice Healthcare Holdings", "methodology": "case rate", "standard_charge_dollar": 18268.58, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon Medicare", "methodology": "case rate", "standard_charge_dollar": 9474.94, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon NJ Health Medicaid", "methodology": "case rate", "standard_charge_dollar": 5406.34 }, { "payer_name": "Humana", "plan_name": "Humana Military Tricare", "methodology": "case rate", "standard_charge_dollar": 9134.29, "additional_payer_notes": "80.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 11417.86, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 9631.11 }, { "payer_name": "UBH", "plan_name": "UBH Medicare", "methodology": "case rate", "standard_charge_dollar": 9474.94, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC All Payer (02-01-2023 to 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 14383.22 }, { "payer_name": "UHC", "plan_name": "UHC Oxford (02-01-2023 to 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 12534.98 }, { "payer_name": "UHC - Adhoc", "plan_name": "UHC - Adhoc All Payer", "methodology": "case rate", "standard_charge_dollar": 15268.1 }, { "payer_name": "UHC - Adhoc", "plan_name": "UHC - Adhoc Oxford", "methodology": "case rate", "standard_charge_dollar": 12917.26 }, { "payer_name": "Wellcare", "plan_name": "Wellcare Insurance Exchange", "methodology": "case rate", "standard_charge_dollar": 15414.11, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "case rate", "standard_charge_dollar": 9474.94, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup Medicare", "methodology": "case rate", "standard_charge_dollar": 9474.94, "additional_payer_notes": "100.00% of Medicare Rates" } ] } ] }, { "description": "POSTPARTUM AND POST ABORTION DIAGNOSIS WITH O.R. PROCEDURE- SOI : 3", "code_information": [ { "code": "5483", "type": "APR-DRG" } ], "standard_charges": [ { "setting": "inpatient", "minimum": 18018.09, "maximum": 19819.9, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Better Health - Medi Medi", "methodology": "case rate", "standard_charge_dollar": 19819.9, "additional_payer_notes": "110% of State Medicaid Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Better Health Medicaid", "methodology": "case rate", "standard_charge_dollar": 19819.9, "additional_payer_notes": "110% of State Medicaid Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "case rate", "standard_charge_dollar": 18018.09, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "UBH", "plan_name": "UBH Medicaid", "methodology": "case rate", "standard_charge_dollar": 18018.09, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicaid (02/01/2023 to 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 18378.45, "additional_payer_notes": "102% of State Medicaid Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicaid", "methodology": "case rate", "standard_charge_dollar": 18018.09, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup Medicaid", "methodology": "case rate", "standard_charge_dollar": 18018.09, "additional_payer_notes": "100% of State Medicaid Rates" } ] } ] }, { "description": "Dilation And Curettage", "code_information": [ { "code": "58120", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 15449.4, "discounted_cash": 3826.0, "minimum": 1715.0, "maximum": 12359.52, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 8113.13, "additional_payer_notes": "212.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medical Rental Network", "methodology": "fee schedule", "standard_charge_dollar": 8113.13, "additional_payer_notes": "212.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3826.95, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "ALLY-ALIGN (FKA SPARTAN PLAN NJ, INC.)", "plan_name": "ALLY-ALIGN (FKA SPARTAN PLAN NJ, INC.)", "methodology": "fee schedule", "standard_charge_dollar": 4018.3, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Americhoice (UHC)", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3826.95, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Amerihealth", "plan_name": "Amerihealth Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3826.95, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 5623.7, "additional_payer_notes": "146.95% of Medicare Rates" }, { "payer_name": "Clover Health", "plan_name": "Clover Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3826.95, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Coventry", "plan_name": "Coventry Auto", "methodology": "fee schedule", "standard_charge_dollar": 7653.9, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Coventry", "plan_name": "Coventry Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 7653.9, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "fee schedule", "standard_charge_dollar": 5357.73, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Fairprice Healthcare Holdings", "plan_name": "Fairprice Healthcare Holdings", "methodology": "fee schedule", "standard_charge_dollar": 6123.12, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ HMO POS", "methodology": "fee schedule", "standard_charge_dollar": 6785.18, "additional_payer_notes": "177.30% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ Indemnity", "methodology": "fee schedule", "standard_charge_dollar": 6785.18, "additional_payer_notes": "177.30% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ PPO", "methodology": "fee schedule", "standard_charge_dollar": 6785.18, "additional_payer_notes": "177.30% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3826.95, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon NJ Health Medicaid", "methodology": "percent of total billed charges", "standard_charge_percentage": 19.58, "median_amount": 2259.53, "10th_percentile": 1059.15, "90th_percentile": 2824.42, "count": "17" }, { "payer_name": "Humana", "plan_name": "Humana Military Tricare", "methodology": "fee schedule", "standard_charge_dollar": 3061.56, "additional_payer_notes": "80.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3826.95, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 3826.95, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC All Payer (02-01-2023 to 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 4415.0 }, { "payer_name": "UHC", "plan_name": "UHC Medicaid (02/01/2023 to 12-31-2026)", "methodology": "percent of total billed charges", "standard_charge_percentage": 19.47, "median_amount": 2439.7, "10th_percentile": 2439.7, "90th_percentile": 2927.64, "count": "1 through 10" }, { "payer_name": "UHC", "plan_name": "UHC Oxford (02-01-2023 to 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 4020.0 }, { "payer_name": "UHC - Adhoc", "plan_name": "UHC - Adhoc All Payer", "methodology": "case rate", "standard_charge_dollar": 4687.0 }, { "payer_name": "UHC - Adhoc", "plan_name": "UHC - Adhoc Oxford", "methodology": "case rate", "standard_charge_dollar": 4143.0 }, { "payer_name": "Wellcare", "plan_name": "Wellcare Insurance Exchange", "methodology": "fee schedule", "standard_charge_dollar": 5166.38, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3826.95, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellchoice", "plan_name": "WELLCHOICE HMO of NJ (Empire) Commercial (HMO / HMO POS, PPO)", "methodology": "case rate", "standard_charge_dollar": 1715.0 }, { "payer_name": "Wellchoice", "plan_name": "WELLCHOICE HMO of NJ (Empire) Commercial (Indemnity)", "methodology": "case rate", "standard_charge_dollar": 1978.0 }, { "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup Medicaid", "methodology": "percent of total billed charges", "standard_charge_percentage": 19.09, "median_amount": 1614.16, "10th_percentile": 807.08, "90th_percentile": 4304.42, "count": "1 through 10" }, { "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3826.95, "additional_payer_notes": "100.00% of Medicare Rates" } ] } ] }, { "description": "Hc I&D Bartholin Gland Abscess", "code_information": [ { "code": "56420", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 818.03, "discounted_cash": 239.0, "minimum": 156.1619, "maximum": 10939.2, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 506.68, "additional_payer_notes": "212.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medical Rental Network", "methodology": "fee schedule", "standard_charge_dollar": 506.68, "additional_payer_notes": "212.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 239.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "ALLY-ALIGN (FKA SPARTAN PLAN NJ, INC.)", "plan_name": "ALLY-ALIGN (FKA SPARTAN PLAN NJ, INC.)", "methodology": "fee schedule", "standard_charge_dollar": 250.95, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Americhoice (UHC)", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 239.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Amerihealth", "plan_name": "Amerihealth Medicare", "methodology": "fee schedule", "standard_charge_dollar": 239.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 351.21, "additional_payer_notes": "146.95% of Medicare Rates" }, { "payer_name": "Clover Health", "plan_name": "Clover Medicare", "methodology": "fee schedule", "standard_charge_dollar": 239.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Coventry", "plan_name": "Coventry Auto", "methodology": "fee schedule", "standard_charge_dollar": 478.0, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Coventry", "plan_name": "Coventry Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 478.0, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "fee schedule", "standard_charge_dollar": 334.6, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Fairprice Healthcare Holdings", "plan_name": "Fairprice Healthcare Holdings", "methodology": "fee schedule", "standard_charge_dollar": 382.4, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ HMO POS", "methodology": "fee schedule", "standard_charge_dollar": 423.75, "additional_payer_notes": "177.30% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ Indemnity", "methodology": "fee schedule", "standard_charge_dollar": 423.75, "additional_payer_notes": "177.30% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ PPO", "methodology": "fee schedule", "standard_charge_dollar": 423.75, "additional_payer_notes": "177.30% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon Medicare", "methodology": "fee schedule", "standard_charge_dollar": 239.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Military Tricare", "methodology": "fee schedule", "standard_charge_dollar": 191.2, "additional_payer_notes": "80.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 239.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 239.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC All Payer (02-01-2023 to 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 818.03 }, { "payer_name": "UHC", "plan_name": "UHC Oxford (02-01-2023 to 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 818.03 }, { "payer_name": "UHC - Adhoc", "plan_name": "UHC - Adhoc All Payer", "methodology": "case rate", "standard_charge_dollar": 818.03 }, { "payer_name": "UHC - Adhoc", "plan_name": "UHC - Adhoc Oxford", "methodology": "case rate", "standard_charge_dollar": 818.03 }, { "payer_name": "Wellcare", "plan_name": "Wellcare Insurance Exchange", "methodology": "fee schedule", "standard_charge_dollar": 322.65, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 239.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellchoice", "plan_name": "WELLCHOICE HMO of NJ (Empire) Commercial (HMO / HMO POS, PPO)", "methodology": "case rate", "standard_charge_dollar": 818.03 }, { "payer_name": "Wellchoice", "plan_name": "WELLCHOICE HMO of NJ (Empire) Commercial (Indemnity)", "methodology": "case rate", "standard_charge_dollar": 818.03 }, { "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup Medicare", "methodology": "fee schedule", "standard_charge_dollar": 239.0, "additional_payer_notes": "100.00% of Medicare Rates" } ] } ] }, { "description": "Hc Open/Perq Placement Intravascular Stent Ea Addl", "code_information": [ { "code": "37237", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 10000.0, "minimum": 1909.0, "maximum": 8000.0, "payers_information": [ { "payer_name": "UHC", "plan_name": "UHC All Payer (02-01-2023 to 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 6624.0 }, { "payer_name": "UHC", "plan_name": "UHC Oxford (02-01-2023 to 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 6317.0 }, { "payer_name": "UHC - Adhoc", "plan_name": "UHC - Adhoc All Payer", "methodology": "case rate", "standard_charge_dollar": 7031.0 }, { "payer_name": "UHC - Adhoc", "plan_name": "UHC - Adhoc Oxford", "methodology": "case rate", "standard_charge_dollar": 6510.0 }, { "payer_name": "Wellchoice", "plan_name": "WELLCHOICE HMO of NJ (Empire) Commercial (HMO / HMO POS, PPO)", "methodology": "case rate", "standard_charge_dollar": 2472.0 }, { "payer_name": "Wellchoice", "plan_name": "WELLCHOICE HMO of NJ (Empire) Commercial (Indemnity)", "methodology": "case rate", "standard_charge_dollar": 2753.0 } ] } ] }, { "description": "Hc Clsd Treat Bimalleolar Ankle Fx W Manip", "code_information": [ { "code": "27810", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 4895.38, "discounted_cash": 1900.0, "minimum": 934.528, "maximum": 4161.073, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 4030.06, "additional_payer_notes": "212.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medical Rental Network", "methodology": "fee schedule", "standard_charge_dollar": 4030.06, "additional_payer_notes": "212.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1900.97, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "ALLY-ALIGN (FKA SPARTAN PLAN NJ, INC.)", "plan_name": "ALLY-ALIGN (FKA SPARTAN PLAN NJ, INC.)", "methodology": "fee schedule", "standard_charge_dollar": 1996.02, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Americhoice (UHC)", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1900.97, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Amerihealth", "plan_name": "Amerihealth Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1900.97, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 2793.48, "additional_payer_notes": "146.95% of Medicare Rates" }, { "payer_name": "Clover Health", "plan_name": "Clover Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1900.97, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Coventry", "plan_name": "Coventry Auto", "methodology": "fee schedule", "standard_charge_dollar": 3801.94, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Coventry", "plan_name": "Coventry Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 3801.94, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "fee schedule", "standard_charge_dollar": 2661.36, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Fairprice Healthcare Holdings", "plan_name": "Fairprice Healthcare Holdings", "methodology": "fee schedule", "standard_charge_dollar": 3041.55, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ HMO POS", "methodology": "fee schedule", "standard_charge_dollar": 3370.42, "additional_payer_notes": "177.30% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ Indemnity", "methodology": "fee schedule", "standard_charge_dollar": 3370.42, "additional_payer_notes": "177.30% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ PPO", "methodology": "fee schedule", "standard_charge_dollar": 3370.42, "additional_payer_notes": "177.30% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1900.97, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Military Tricare", "methodology": "fee schedule", "standard_charge_dollar": 1520.78, "additional_payer_notes": "80.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1900.97, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 1900.97, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC All Payer (02-01-2023 to 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 3147.0 }, { "payer_name": "UHC", "plan_name": "UHC Oxford (02-01-2023 to 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 2297.0 }, { "payer_name": "UHC - Adhoc", "plan_name": "UHC - Adhoc All Payer", "methodology": "case rate", "standard_charge_dollar": 3341.0 }, { "payer_name": "UHC - Adhoc", "plan_name": "UHC - Adhoc Oxford", "methodology": "case rate", "standard_charge_dollar": 2367.0 }, { "payer_name": "Wellcare", "plan_name": "Wellcare Insurance Exchange", "methodology": "fee schedule", "standard_charge_dollar": 2566.31, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1900.97, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1900.97, "additional_payer_notes": "100.00% of Medicare Rates" } ] } ] }, { "description": "SP BONE AGRFT MORSEL ADD-ON", "code_information": [ { "code": "20937", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 4697.87, "minimum": 896.8234, "maximum": 4697.87, "payers_information": [ { "payer_name": "UHC", "plan_name": "UHC All Payer (02-01-2023 to 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 4697.87 }, { "payer_name": "UHC", "plan_name": "UHC Oxford (02-01-2023 to 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 4697.87 }, { "payer_name": "UHC - Adhoc", "plan_name": "UHC - Adhoc All Payer", "methodology": "case rate", "standard_charge_dollar": 4697.87 }, { "payer_name": "UHC - Adhoc", "plan_name": "UHC - Adhoc Oxford", "methodology": "case rate", "standard_charge_dollar": 4697.87 }, { "payer_name": "Wellchoice", "plan_name": "WELLCHOICE HMO of NJ (Empire) Commercial (HMO / HMO POS, PPO)", "methodology": "case rate", "standard_charge_dollar": 1715.0 }, { "payer_name": "Wellchoice", "plan_name": "WELLCHOICE HMO of NJ (Empire) Commercial (Indemnity)", "methodology": "case rate", "standard_charge_dollar": 1978.0 } ] } ] }, { "description": "Hc Arc Rbc Pretreatment/Enzym", "code_information": [ { "code": "86971", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 171.0, "discounted_cash": 201.0, "minimum": 15.0, "maximum": 171.0, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 171.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "ALLY-ALIGN (FKA SPARTAN PLAN NJ, INC.)", "plan_name": "ALLY-ALIGN (FKA SPARTAN PLAN NJ, INC.)", "methodology": "fee schedule", "standard_charge_dollar": 171.0, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Americhoice (UHC)", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 171.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Amerihealth", "plan_name": "Amerihealth Medicare", "methodology": "fee schedule", "standard_charge_dollar": 171.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 171.0, "additional_payer_notes": "146.95% of Medicare Rates" }, { "payer_name": "Clover Health", "plan_name": "Clover Medicare", "methodology": "fee schedule", "standard_charge_dollar": 171.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Coventry", "plan_name": "Coventry Auto", "methodology": "fee schedule", "standard_charge_dollar": 171.0, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Coventry", "plan_name": "Coventry Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 171.0, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "fee schedule", "standard_charge_dollar": 171.0, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Fairprice Healthcare Holdings", "plan_name": "Fairprice Healthcare Holdings", "methodology": "fee schedule", "standard_charge_dollar": 171.0, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ HMO POS", "methodology": "fee schedule", "standard_charge_dollar": 171.0, "additional_payer_notes": "177.30% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ Indemnity", "methodology": "fee schedule", "standard_charge_dollar": 171.0, "additional_payer_notes": "177.30% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ PPO", "methodology": "fee schedule", "standard_charge_dollar": 171.0, "additional_payer_notes": "177.30% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon Medicare", "methodology": "fee schedule", "standard_charge_dollar": 171.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Military Tricare", "methodology": "fee schedule", "standard_charge_dollar": 161.13, "additional_payer_notes": "80.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 171.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 171.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC All Payer (02-01-2023 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 170.05 }, { "payer_name": "UHC", "plan_name": "UHC Medicaid (02/01/2023 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 15.0 }, { "payer_name": "UHC", "plan_name": "UHC Oxford (02-01-2023 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 170.05 }, { "payer_name": "UHC - Adhoc", "plan_name": "UHC - Adhoc All Payer", "methodology": "fee schedule", "standard_charge_dollar": 171.0 }, { "payer_name": "UHC - Adhoc", "plan_name": "UHC - Adhoc Oxford", "methodology": "fee schedule", "standard_charge_dollar": 171.0 }, { "payer_name": "Wellcare", "plan_name": "Wellcare Insurance Exchange", "methodology": "fee schedule", "standard_charge_dollar": 171.0, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 171.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup Medicare", "methodology": "fee schedule", "standard_charge_dollar": 171.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 171.0, "additional_payer_notes": "212.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medical Rental Network", "methodology": "fee schedule", "standard_charge_dollar": 171.0, "additional_payer_notes": "212.00% of Medicare Rates" } ] } ] }, { "description": "Hc Remove Fb Pharynx", "code_information": [ { "code": "42809", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 1297.74, "discounted_cash": 528.0, "minimum": 247.7386, "maximum": 1297.74, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 1119.61, "additional_payer_notes": "212.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medical Rental Network", "methodology": "fee schedule", "standard_charge_dollar": 1119.61, "additional_payer_notes": "212.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 528.12, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "ALLY-ALIGN (FKA SPARTAN PLAN NJ, INC.)", "plan_name": "ALLY-ALIGN (FKA SPARTAN PLAN NJ, INC.)", "methodology": "fee schedule", "standard_charge_dollar": 554.53, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Americhoice (UHC)", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 528.12, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Amerihealth", "plan_name": "Amerihealth Medicare", "methodology": "fee schedule", "standard_charge_dollar": 528.12, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 776.07, "additional_payer_notes": "146.95% of Medicare Rates" }, { "payer_name": "Clover Health", "plan_name": "Clover Medicare", "methodology": "fee schedule", "standard_charge_dollar": 528.12, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Coventry", "plan_name": "Coventry Auto", "methodology": "fee schedule", "standard_charge_dollar": 1056.24, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Coventry", "plan_name": "Coventry Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 1056.24, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "fee schedule", "standard_charge_dollar": 739.37, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Fairprice Healthcare Holdings", "plan_name": "Fairprice Healthcare Holdings", "methodology": "fee schedule", "standard_charge_dollar": 844.99, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ HMO POS", "methodology": "fee schedule", "standard_charge_dollar": 936.36, "additional_payer_notes": "177.30% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ Indemnity", "methodology": "fee schedule", "standard_charge_dollar": 936.36, "additional_payer_notes": "177.30% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ PPO", "methodology": "fee schedule", "standard_charge_dollar": 936.36, "additional_payer_notes": "177.30% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon Medicare", "methodology": "fee schedule", "standard_charge_dollar": 528.12, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Military Tricare", "methodology": "fee schedule", "standard_charge_dollar": 422.5, "additional_payer_notes": "80.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 528.12, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 528.12, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC All Payer (02-01-2023 to 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 1297.74 }, { "payer_name": "UHC", "plan_name": "UHC Oxford (02-01-2023 to 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 1297.74 }, { "payer_name": "UHC - Adhoc", "plan_name": "UHC - Adhoc All Payer", "methodology": "case rate", "standard_charge_dollar": 1297.74 }, { "payer_name": "UHC - Adhoc", "plan_name": "UHC - Adhoc Oxford", "methodology": "case rate", "standard_charge_dollar": 1297.74 }, { "payer_name": "Wellcare", "plan_name": "Wellcare Insurance Exchange", "methodology": "fee schedule", "standard_charge_dollar": 712.96, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 528.12, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellchoice", "plan_name": "WELLCHOICE HMO of NJ (Empire) Commercial (HMO / HMO POS, PPO)", "methodology": "case rate", "standard_charge_dollar": 1297.74 }, { "payer_name": "Wellchoice", "plan_name": "WELLCHOICE HMO of NJ (Empire) Commercial (Indemnity)", "methodology": "case rate", "standard_charge_dollar": 1297.74 }, { "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup Medicare", "methodology": "fee schedule", "standard_charge_dollar": 528.12, "additional_payer_notes": "100.00% of Medicare Rates" } ] } ] }, { "description": "Repair Of Leg Tendon Each - 27664 - OR36027664", "code_information": [ { "code": "27664", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 56257.5, "discounted_cash": 8578.0, "minimum": 1715.0, "maximum": 45006.0, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 18186.06, "additional_payer_notes": "212.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medical Rental Network", "methodology": "fee schedule", "standard_charge_dollar": 18186.06, "additional_payer_notes": "212.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 8578.33, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "ALLY-ALIGN (FKA SPARTAN PLAN NJ, INC.)", "plan_name": "ALLY-ALIGN (FKA SPARTAN PLAN NJ, INC.)", "methodology": "fee schedule", "standard_charge_dollar": 9007.25, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Americhoice (UHC)", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 8578.33, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Amerihealth", "plan_name": "Amerihealth Medicare", "methodology": "fee schedule", "standard_charge_dollar": 8578.33, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 12605.86, "additional_payer_notes": "146.95% of Medicare Rates" }, { "payer_name": "Clover Health", "plan_name": "Clover Medicare", "methodology": "fee schedule", "standard_charge_dollar": 8578.33, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Coventry", "plan_name": "Coventry Auto", "methodology": "fee schedule", "standard_charge_dollar": 17156.66, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Coventry", "plan_name": "Coventry Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 17156.66, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "fee schedule", "standard_charge_dollar": 12009.66, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Fairprice Healthcare Holdings", "plan_name": "Fairprice Healthcare Holdings", "methodology": "fee schedule", "standard_charge_dollar": 13725.33, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ HMO POS", "methodology": "fee schedule", "standard_charge_dollar": 15209.38, "additional_payer_notes": "177.30% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ Indemnity", "methodology": "fee schedule", "standard_charge_dollar": 15209.38, "additional_payer_notes": "177.30% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ PPO", "methodology": "fee schedule", "standard_charge_dollar": 15209.38, "additional_payer_notes": "177.30% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon Medicare", "methodology": "fee schedule", "standard_charge_dollar": 8578.33, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Military Tricare", "methodology": "fee schedule", "standard_charge_dollar": 6862.66, "additional_payer_notes": "80.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 8578.33, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 8578.33, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC All Payer (02-01-2023 to 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 5378.0 }, { "payer_name": "UHC", "plan_name": "UHC Oxford (02-01-2023 to 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 5169.0 }, { "payer_name": "UHC - Adhoc", "plan_name": "UHC - Adhoc All Payer", "methodology": "case rate", "standard_charge_dollar": 5709.0 }, { "payer_name": "UHC - Adhoc", "plan_name": "UHC - Adhoc Oxford", "methodology": "case rate", "standard_charge_dollar": 5327.0 }, { "payer_name": "Wellcare", "plan_name": "Wellcare Insurance Exchange", "methodology": "fee schedule", "standard_charge_dollar": 11580.75, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 8578.33, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellchoice", "plan_name": "WELLCHOICE HMO of NJ (Empire) Commercial (HMO / HMO POS, PPO)", "methodology": "case rate", "standard_charge_dollar": 1715.0 }, { "payer_name": "Wellchoice", "plan_name": "WELLCHOICE HMO of NJ (Empire) Commercial (Indemnity)", "methodology": "case rate", "standard_charge_dollar": 1978.0 }, { "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup Medicare", "methodology": "fee schedule", "standard_charge_dollar": 8578.33, "additional_payer_notes": "100.00% of Medicare Rates" } ] } ] }, { "description": "Hc Ketone Bodies Serum Qualitative", "code_information": [ { "code": "82009", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 40.0, "discounted_cash": 4.0, "minimum": 2.71, "maximum": 34.0, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 9.58, "additional_payer_notes": "212.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medical Rental Network", "methodology": "fee schedule", "standard_charge_dollar": 9.58, "additional_payer_notes": "212.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 4.52, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "ALLY-ALIGN (FKA SPARTAN PLAN NJ, INC.)", "plan_name": "ALLY-ALIGN (FKA SPARTAN PLAN NJ, INC.)", "methodology": "fee schedule", "standard_charge_dollar": 4.75, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Americhoice (UHC)", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 4.52, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Amerihealth", "plan_name": "Amerihealth Medicare", "methodology": "fee schedule", "standard_charge_dollar": 4.52, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 6.55, "additional_payer_notes": "Laboratory - 145.00% of Medicare Rates" }, { "payer_name": "Clover Health", "plan_name": "Clover Medicare", "methodology": "fee schedule", "standard_charge_dollar": 4.52, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Coventry", "plan_name": "Coventry Auto", "methodology": "fee schedule", "standard_charge_dollar": 9.04, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Coventry", "plan_name": "Coventry Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 9.04, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "fee schedule", "standard_charge_dollar": 6.33, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Fairprice Healthcare Holdings", "plan_name": "Fairprice Healthcare Holdings", "methodology": "fee schedule", "standard_charge_dollar": 5.42, "additional_payer_notes": "Laboratory - 120.00% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ HMO POS", "methodology": "fee schedule", "standard_charge_dollar": 28.24, "additional_payer_notes": "177.30% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ Indemnity", "methodology": "fee schedule", "standard_charge_dollar": 28.24, "additional_payer_notes": "177.30% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ PPO", "methodology": "fee schedule", "standard_charge_dollar": 28.24, "additional_payer_notes": "177.30% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon Medicare", "methodology": "fee schedule", "standard_charge_dollar": 4.52, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Military Tricare", "methodology": "fee schedule", "standard_charge_dollar": 3.62, "additional_payer_notes": "80.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 4.52, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 4.52, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC All Payer (02-01-2023 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 2.71 }, { "payer_name": "UHC", "plan_name": "UHC Medicaid (02/01/2023 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 3.62 }, { "payer_name": "UHC", "plan_name": "UHC Oxford (02-01-2023 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 2.71 }, { "payer_name": "UHC - Adhoc", "plan_name": "UHC - Adhoc All Payer", "methodology": "fee schedule", "standard_charge_dollar": 4.52 }, { "payer_name": "UHC - Adhoc", "plan_name": "UHC - Adhoc Oxford", "methodology": "fee schedule", "standard_charge_dollar": 4.52 }, { "payer_name": "Wellcare", "plan_name": "Wellcare Insurance Exchange", "methodology": "fee schedule", "standard_charge_dollar": 6.1, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 4.52, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup Medicare", "methodology": "fee schedule", "standard_charge_dollar": 4.52, "additional_payer_notes": "100.00% of Medicare Rates" } ] } ] }, { "description": "MALE REPRODUCTIVE SYSTEM DIAGNOSES EXCEPT MALIGNANCY - SOI : 3", "code_information": [ { "code": "5013", "type": "APR-DRG" } ], "standard_charges": [ { "setting": "inpatient", "minimum": 11312.56, "maximum": 12443.81, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Better Health - Medi Medi", "methodology": "case rate", "standard_charge_dollar": 12443.81, "additional_payer_notes": "110% of State Medicaid Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Better Health Medicaid", "methodology": "case rate", "standard_charge_dollar": 12443.81, "additional_payer_notes": "110% of State Medicaid Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "case rate", "standard_charge_dollar": 11312.56, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "UBH", "plan_name": "UBH Medicaid", "methodology": "case rate", "standard_charge_dollar": 11312.56, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicaid (02/01/2023 to 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 11538.81, "additional_payer_notes": "102% of State Medicaid Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicaid", "methodology": "case rate", "standard_charge_dollar": 11312.56, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup Medicaid", "methodology": "case rate", "standard_charge_dollar": 11312.56, "additional_payer_notes": "100% of State Medicaid Rates" } ] } ] }, { "description": "Hc Ro Radn Rx Delivery >=1 Mev Simple", "code_information": [ { "code": "77402", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 650.0, "discounted_cash": 120.0, "minimum": 96.496, "maximum": 650.0, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 255.71, "additional_payer_notes": "212.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medical Rental Network", "methodology": "fee schedule", "standard_charge_dollar": 255.71, "additional_payer_notes": "212.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 120.62, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "ALLY-ALIGN (FKA SPARTAN PLAN NJ, INC.)", "plan_name": "ALLY-ALIGN (FKA SPARTAN PLAN NJ, INC.)", "methodology": "fee schedule", "standard_charge_dollar": 126.65, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Americhoice (UHC)", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 120.62, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Amerihealth", "plan_name": "Amerihealth Medicare", "methodology": "fee schedule", "standard_charge_dollar": 120.62, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 177.25, "additional_payer_notes": "146.95% of Medicare Rates" }, { "payer_name": "Clover Health", "plan_name": "Clover Medicare", "methodology": "fee schedule", "standard_charge_dollar": 120.62, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Coventry", "plan_name": "Coventry Auto", "methodology": "fee schedule", "standard_charge_dollar": 241.24, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Coventry", "plan_name": "Coventry Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 241.24, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "fee schedule", "standard_charge_dollar": 168.87, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Fairprice Healthcare Holdings", "plan_name": "Fairprice Healthcare Holdings", "methodology": "fee schedule", "standard_charge_dollar": 192.99, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ HMO POS", "methodology": "fee schedule", "standard_charge_dollar": 213.86, "additional_payer_notes": "177.30% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ Indemnity", "methodology": "fee schedule", "standard_charge_dollar": 213.86, "additional_payer_notes": "177.30% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ PPO", "methodology": "fee schedule", "standard_charge_dollar": 213.86, "additional_payer_notes": "177.30% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon Medicare", "methodology": "fee schedule", "standard_charge_dollar": 120.62, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Military Tricare", "methodology": "fee schedule", "standard_charge_dollar": 96.5, "additional_payer_notes": "80.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 120.62, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 120.62, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC All Payer (02-01-2023 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 650.0 }, { "payer_name": "UHC", "plan_name": "UHC Oxford (02-01-2023 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 650.0 }, { "payer_name": "UHC - Adhoc", "plan_name": "UHC - Adhoc All Payer", "methodology": "fee schedule", "standard_charge_dollar": 650.0 }, { "payer_name": "UHC - Adhoc", "plan_name": "UHC - Adhoc Oxford", "methodology": "fee schedule", "standard_charge_dollar": 650.0 }, { "payer_name": "Wellcare", "plan_name": "Wellcare Insurance Exchange", "methodology": "fee schedule", "standard_charge_dollar": 162.84, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 120.62, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellchoice", "plan_name": "WELLCHOICE HMO of NJ (Empire) Commercial (HMO / HMO POS, PPO)", "methodology": "case rate", "standard_charge_dollar": 167.0 }, { "payer_name": "Wellchoice", "plan_name": "WELLCHOICE HMO of NJ (Empire) Commercial (Indemnity)", "methodology": "case rate", "standard_charge_dollar": 202.0 }, { "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup Medicare", "methodology": "fee schedule", "standard_charge_dollar": 120.62, "additional_payer_notes": "100.00% of Medicare Rates" } ] } ] }, { "description": "Hc Mediast W/Expl Drg Rmvl Fb/Bx Crv Appr", "code_information": [ { "code": "39000", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 1000.0, "minimum": 190.9, "maximum": 1000.0, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 512.42, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC All Payer (02-01-2023 to 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 1000.0 }, { "payer_name": "UHC", "plan_name": "UHC Oxford (02-01-2023 to 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 1000.0 }, { "payer_name": "UHC - Adhoc", "plan_name": "UHC - Adhoc All Payer", "methodology": "case rate", "standard_charge_dollar": 1000.0 }, { "payer_name": "UHC - Adhoc", "plan_name": "UHC - Adhoc Oxford", "methodology": "case rate", "standard_charge_dollar": 1000.0 }, { "payer_name": "Wellchoice", "plan_name": "WELLCHOICE HMO of NJ (Empire) Commercial (HMO / HMO POS, PPO)", "methodology": "case rate", "standard_charge_dollar": 1000.0 }, { "payer_name": "Wellchoice", "plan_name": "WELLCHOICE HMO of NJ (Empire) Commercial (Indemnity)", "methodology": "case rate", "standard_charge_dollar": 1000.0 } ] } ] }, { "description": "Hc Repr Wnd Intrmd Body/Scalp/Extr 12.5-20 Cm", "code_information": [ { "code": "12035", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 1170.71, "discounted_cash": 480.0, "minimum": 223.4885, "maximum": 1170.71, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 1018.83, "additional_payer_notes": "212.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medical Rental Network", "methodology": "fee schedule", "standard_charge_dollar": 1018.83, "additional_payer_notes": "212.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 480.58, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "ALLY-ALIGN (FKA SPARTAN PLAN NJ, INC.)", "plan_name": "ALLY-ALIGN (FKA SPARTAN PLAN NJ, INC.)", "methodology": "fee schedule", "standard_charge_dollar": 504.61, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Americhoice (UHC)", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 480.58, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Amerihealth", "plan_name": "Amerihealth Medicare", "methodology": "fee schedule", "standard_charge_dollar": 480.58, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 706.21, "additional_payer_notes": "146.95% of Medicare Rates" }, { "payer_name": "Clover Health", "plan_name": "Clover Medicare", "methodology": "fee schedule", "standard_charge_dollar": 480.58, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Coventry", "plan_name": "Coventry Auto", "methodology": "fee schedule", "standard_charge_dollar": 961.16, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Coventry", "plan_name": "Coventry Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 961.16, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "fee schedule", "standard_charge_dollar": 672.81, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Fairprice Healthcare Holdings", "plan_name": "Fairprice Healthcare Holdings", "methodology": "fee schedule", "standard_charge_dollar": 768.93, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ HMO POS", "methodology": "fee schedule", "standard_charge_dollar": 852.07, "additional_payer_notes": "177.30% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ Indemnity", "methodology": "fee schedule", "standard_charge_dollar": 852.07, "additional_payer_notes": "177.30% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ PPO", "methodology": "fee schedule", "standard_charge_dollar": 852.07, "additional_payer_notes": "177.30% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon Medicare", "methodology": "fee schedule", "standard_charge_dollar": 480.58, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Military Tricare", "methodology": "fee schedule", "standard_charge_dollar": 384.46, "additional_payer_notes": "80.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 480.58, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 480.58, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC All Payer (02-01-2023 to 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 1170.71 }, { "payer_name": "UHC", "plan_name": "UHC Oxford (02-01-2023 to 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 1170.71 }, { "payer_name": "UHC - Adhoc", "plan_name": "UHC - Adhoc All Payer", "methodology": "case rate", "standard_charge_dollar": 1170.71 }, { "payer_name": "UHC - Adhoc", "plan_name": "UHC - Adhoc Oxford", "methodology": "case rate", "standard_charge_dollar": 1170.71 }, { "payer_name": "Wellcare", "plan_name": "Wellcare Insurance Exchange", "methodology": "fee schedule", "standard_charge_dollar": 648.78, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 480.58, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellchoice", "plan_name": "WELLCHOICE HMO of NJ (Empire) Commercial (HMO / HMO POS, PPO)", "methodology": "case rate", "standard_charge_dollar": 1170.71 }, { "payer_name": "Wellchoice", "plan_name": "WELLCHOICE HMO of NJ (Empire) Commercial (Indemnity)", "methodology": "case rate", "standard_charge_dollar": 1170.71 }, { "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup Medicare", "methodology": "fee schedule", "standard_charge_dollar": 480.58, "additional_payer_notes": "100.00% of Medicare Rates" } ] } ] }, { "description": "Excise pharynx lesion", "code_information": [ { "code": "42808", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 5770.0, "discounted_cash": 3919.0, "minimum": 1101.493, "maximum": 5770.0, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 5770.0, "additional_payer_notes": "212.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medical Rental Network", "methodology": "fee schedule", "standard_charge_dollar": 5770.0, "additional_payer_notes": "212.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3919.55, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "ALLY-ALIGN (FKA SPARTAN PLAN NJ, INC.)", "plan_name": "ALLY-ALIGN (FKA SPARTAN PLAN NJ, INC.)", "methodology": "fee schedule", "standard_charge_dollar": 4115.53, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Americhoice (UHC)", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3919.55, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Amerihealth", "plan_name": "Amerihealth Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3919.55, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 5759.78, "additional_payer_notes": "146.95% of Medicare Rates" }, { "payer_name": "Clover Health", "plan_name": "Clover Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3919.55, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Coventry", "plan_name": "Coventry Auto", "methodology": "fee schedule", "standard_charge_dollar": 5770.0, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Coventry", "plan_name": "Coventry Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 5770.0, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "fee schedule", "standard_charge_dollar": 5487.37, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Fairprice Healthcare Holdings", "plan_name": "Fairprice Healthcare Holdings", "methodology": "fee schedule", "standard_charge_dollar": 5770.0, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ HMO POS", "methodology": "fee schedule", "standard_charge_dollar": 5770.0, "additional_payer_notes": "177.30% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ Indemnity", "methodology": "fee schedule", "standard_charge_dollar": 5770.0, "additional_payer_notes": "177.30% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ PPO", "methodology": "fee schedule", "standard_charge_dollar": 5770.0, "additional_payer_notes": "177.30% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3919.55, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Military Tricare", "methodology": "fee schedule", "standard_charge_dollar": 3135.64, "additional_payer_notes": "80.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3919.55, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 3919.55, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC All Payer (02-01-2023 to 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 4415.0 }, { "payer_name": "UHC", "plan_name": "UHC Oxford (02-01-2023 to 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 4020.0 }, { "payer_name": "UHC - Adhoc", "plan_name": "UHC - Adhoc All Payer", "methodology": "case rate", "standard_charge_dollar": 4687.0 }, { "payer_name": "UHC - Adhoc", "plan_name": "UHC - Adhoc Oxford", "methodology": "case rate", "standard_charge_dollar": 4143.0 }, { "payer_name": "Wellcare", "plan_name": "Wellcare Insurance Exchange", "methodology": "fee schedule", "standard_charge_dollar": 5291.39, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3919.55, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellchoice", "plan_name": "WELLCHOICE HMO of NJ (Empire) Commercial (HMO / HMO POS, PPO)", "methodology": "case rate", "standard_charge_dollar": 1715.0 }, { "payer_name": "Wellchoice", "plan_name": "WELLCHOICE HMO of NJ (Empire) Commercial (Indemnity)", "methodology": "case rate", "standard_charge_dollar": 1978.0 }, { "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3919.55, "additional_payer_notes": "100.00% of Medicare Rates" } ] } ] }, { "description": "Hc Narcosynthesis", "code_information": [ { "code": "90865", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 432.0, "discounted_cash": 209.0, "minimum": 79.31, "maximum": 432.0, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 432.0, "additional_payer_notes": "212.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medical Rental Network", "methodology": "fee schedule", "standard_charge_dollar": 432.0, "additional_payer_notes": "212.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 209.83, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "ALLY-ALIGN (FKA SPARTAN PLAN NJ, INC.)", "plan_name": "ALLY-ALIGN (FKA SPARTAN PLAN NJ, INC.)", "methodology": "fee schedule", "standard_charge_dollar": 220.32, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Americhoice (UHC)", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 209.83, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Amerihealth", "plan_name": "Amerihealth Medicare", "methodology": "fee schedule", "standard_charge_dollar": 209.83, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 308.35, "additional_payer_notes": "146.95% of Medicare Rates" }, { "payer_name": "Clover Health", "plan_name": "Clover Medicare", "methodology": "fee schedule", "standard_charge_dollar": 209.83, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Coventry", "plan_name": "Coventry Auto", "methodology": "fee schedule", "standard_charge_dollar": 419.66, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Coventry", "plan_name": "Coventry Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 419.66, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "fee schedule", "standard_charge_dollar": 293.76, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Fairprice Healthcare Holdings", "plan_name": "Fairprice Healthcare Holdings", "methodology": "fee schedule", "standard_charge_dollar": 335.73, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ HMO POS", "methodology": "fee schedule", "standard_charge_dollar": 372.03, "additional_payer_notes": "177.30% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ Indemnity", "methodology": "fee schedule", "standard_charge_dollar": 372.03, "additional_payer_notes": "177.30% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ PPO", "methodology": "fee schedule", "standard_charge_dollar": 372.03, "additional_payer_notes": "177.30% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon Medicare", "methodology": "fee schedule", "standard_charge_dollar": 209.83, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon NJ Health Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 79.31 }, { "payer_name": "Humana", "plan_name": "Humana Military Tricare", "methodology": "fee schedule", "standard_charge_dollar": 167.86, "additional_payer_notes": "80.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 209.83, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 209.83, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UBH", "plan_name": "UBH Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 79.31 }, { "payer_name": "UHC", "plan_name": "UHC Medicaid (02/01/2023 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 79.31 }, { "payer_name": "Wellcare", "plan_name": "Wellcare Insurance Exchange", "methodology": "fee schedule", "standard_charge_dollar": 283.27, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 209.83, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup Medicare", "methodology": "fee schedule", "standard_charge_dollar": 209.83, "additional_payer_notes": "100.00% of Medicare Rates" } ] } ] }, { "description": "Hc (Sup Shell C1758) Catheter Ureteral", "code_information": [ { "code": "C1758", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "payers_information": [ { "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup Medicaid", "methodology": "percent of total billed charges", "standard_charge_percentage": 19.09, "median_amount": 27.98, "10th_percentile": 27.98, "90th_percentile": 27.98, "count": "1 through 10" } ] } ] }, { "description": "Hc (Sup Shell C1781) Mesh", "code_information": [ { "code": "C1781", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "payers_information": [ { "payer_name": "Horizon", "plan_name": "Horizon NJ Health Medicaid", "methodology": "percent of total billed charges", "standard_charge_percentage": 19.58, "median_amount": 577.55, "10th_percentile": 425.59, "90th_percentile": 1155.1, "count": "13" }, { "payer_name": "UHC", "plan_name": "UHC Medicaid (02/01/2023 to 12-31-2026)", "methodology": "percent of total billed charges", "standard_charge_percentage": 19.47, "median_amount": 561.12, "10th_percentile": 331.13, "90th_percentile": 1118.78, "count": "1 through 10" }, { "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup Medicaid", "methodology": "percent of total billed charges", "standard_charge_percentage": 19.09, "median_amount": 324.64, "10th_percentile": 324.64, "90th_percentile": 524.01, "count": "1 through 10" } ] } ] }, { "description": "Hc Assay Of Triglycerides", "code_information": [ { "code": "84478", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 100.0, "discounted_cash": 5.0, "minimum": 3.44, "maximum": 85.0, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 12.17, "additional_payer_notes": "212.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medical Rental Network", "methodology": "fee schedule", "standard_charge_dollar": 12.17, "additional_payer_notes": "212.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5.74, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "ALLY-ALIGN (FKA SPARTAN PLAN NJ, INC.)", "plan_name": "ALLY-ALIGN (FKA SPARTAN PLAN NJ, INC.)", "methodology": "fee schedule", "standard_charge_dollar": 6.03, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Americhoice (UHC)", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5.74, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Amerihealth", "plan_name": "Amerihealth Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5.74, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 8.32, "additional_payer_notes": "A Indicator - 155.00% of Medicare Rates" }, { "payer_name": "Clover Health", "plan_name": "Clover Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5.74, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Coventry", "plan_name": "Coventry Auto", "methodology": "fee schedule", "standard_charge_dollar": 11.48, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Coventry", "plan_name": "Coventry Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 11.48, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "fee schedule", "standard_charge_dollar": 8.04, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Fairprice Healthcare Holdings", "plan_name": "Fairprice Healthcare Holdings", "methodology": "fee schedule", "standard_charge_dollar": 6.89, "additional_payer_notes": "Laboratory - 120.00% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ HMO POS", "methodology": "fee schedule", "standard_charge_dollar": 70.6, "additional_payer_notes": "177.30% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ Indemnity", "methodology": "fee schedule", "standard_charge_dollar": 70.6, "additional_payer_notes": "177.30% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ PPO", "methodology": "fee schedule", "standard_charge_dollar": 70.6, "additional_payer_notes": "177.30% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5.74, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Military Tricare", "methodology": "fee schedule", "standard_charge_dollar": 4.59, "additional_payer_notes": "80.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5.74, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 5.74, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC All Payer (02-01-2023 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 3.44 }, { "payer_name": "UHC", "plan_name": "UHC Medicaid (02/01/2023 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 4.59 }, { "payer_name": "UHC", "plan_name": "UHC Oxford (02-01-2023 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 3.44 }, { "payer_name": "UHC - Adhoc", "plan_name": "UHC - Adhoc All Payer", "methodology": "fee schedule", "standard_charge_dollar": 5.74 }, { "payer_name": "UHC - Adhoc", "plan_name": "UHC - Adhoc Oxford", "methodology": "fee schedule", "standard_charge_dollar": 5.74 }, { "payer_name": "Wellcare", "plan_name": "Wellcare Insurance Exchange", "methodology": "fee schedule", "standard_charge_dollar": 7.75, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5.74, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5.74, "additional_payer_notes": "100.00% of Medicare Rates" } ] } ] }, { "description": "Hc Specimen Concentrat, Infect Agents", "code_information": [ { "code": "87015", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 39.0, "discounted_cash": 6.0, "minimum": 4.01, "maximum": 33.15, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 14.16, "additional_payer_notes": "212.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medical Rental Network", "methodology": "fee schedule", "standard_charge_dollar": 14.16, "additional_payer_notes": "212.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 6.68, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "ALLY-ALIGN (FKA SPARTAN PLAN NJ, INC.)", "plan_name": "ALLY-ALIGN (FKA SPARTAN PLAN NJ, INC.)", "methodology": "fee schedule", "standard_charge_dollar": 7.01, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Americhoice (UHC)", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 6.68, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Amerihealth", "plan_name": "Amerihealth Medicare", "methodology": "fee schedule", "standard_charge_dollar": 6.68, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 9.69, "additional_payer_notes": "Laboratory - 145.00% of Medicare Rates" }, { "payer_name": "Clover Health", "plan_name": "Clover Medicare", "methodology": "fee schedule", "standard_charge_dollar": 6.68, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Coventry", "plan_name": "Coventry Auto", "methodology": "fee schedule", "standard_charge_dollar": 13.36, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Coventry", "plan_name": "Coventry Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 13.36, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "fee schedule", "standard_charge_dollar": 9.35, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Fairprice Healthcare Holdings", "plan_name": "Fairprice Healthcare Holdings", "methodology": "fee schedule", "standard_charge_dollar": 8.02, "additional_payer_notes": "Laboratory - 120.00% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ HMO POS", "methodology": "fee schedule", "standard_charge_dollar": 27.53, "additional_payer_notes": "177.30% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ Indemnity", "methodology": "fee schedule", "standard_charge_dollar": 27.53, "additional_payer_notes": "177.30% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ PPO", "methodology": "fee schedule", "standard_charge_dollar": 27.53, "additional_payer_notes": "177.30% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon Medicare", "methodology": "fee schedule", "standard_charge_dollar": 6.68, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Military Tricare", "methodology": "fee schedule", "standard_charge_dollar": 5.34, "additional_payer_notes": "80.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 6.68, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 6.68, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC All Payer (02-01-2023 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 4.01 }, { "payer_name": "UHC", "plan_name": "UHC Medicaid (02/01/2023 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 5.34 }, { "payer_name": "UHC", "plan_name": "UHC Oxford (02-01-2023 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 4.01 }, { "payer_name": "UHC - Adhoc", "plan_name": "UHC - Adhoc All Payer", "methodology": "fee schedule", "standard_charge_dollar": 6.68 }, { "payer_name": "UHC - Adhoc", "plan_name": "UHC - Adhoc Oxford", "methodology": "fee schedule", "standard_charge_dollar": 6.68 }, { "payer_name": "Wellcare", "plan_name": "Wellcare Insurance Exchange", "methodology": "fee schedule", "standard_charge_dollar": 9.02, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 6.68, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup Medicare", "methodology": "fee schedule", "standard_charge_dollar": 6.68, "additional_payer_notes": "100.00% of Medicare Rates" } ] } ] }, { "description": "Hc X-Ray Sacroiliac Jts 3+ Vw", "code_information": [ { "code": "72202", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 562.55, "discounted_cash": 123.0, "minimum": 53.2, "maximum": 478.1675, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 262.01, "additional_payer_notes": "212.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medical Rental Network", "methodology": "fee schedule", "standard_charge_dollar": 262.01, "additional_payer_notes": "212.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 123.59, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "ALLY-ALIGN (FKA SPARTAN PLAN NJ, INC.)", "plan_name": "ALLY-ALIGN (FKA SPARTAN PLAN NJ, INC.)", "methodology": "fee schedule", "standard_charge_dollar": 129.77, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Americhoice (UHC)", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 123.59, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Amerihealth", "plan_name": "Amerihealth HMO", "methodology": "fee schedule", "standard_charge_dollar": 53.2 }, { "payer_name": "Amerihealth", "plan_name": "Amerihealth Medicare", "methodology": "fee schedule", "standard_charge_dollar": 123.59, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 181.62, "additional_payer_notes": "146.95% of Medicare Rates" }, { "payer_name": "Clover Health", "plan_name": "Clover Medicare", "methodology": "fee schedule", "standard_charge_dollar": 123.59, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Coventry", "plan_name": "Coventry Auto", "methodology": "fee schedule", "standard_charge_dollar": 247.18, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Coventry", "plan_name": "Coventry Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 247.18, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "fee schedule", "standard_charge_dollar": 173.03, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Fairprice Healthcare Holdings", "plan_name": "Fairprice Healthcare Holdings", "methodology": "fee schedule", "standard_charge_dollar": 197.74, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ HMO POS", "methodology": "fee schedule", "standard_charge_dollar": 219.13, "additional_payer_notes": "177.30% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ Indemnity", "methodology": "fee schedule", "standard_charge_dollar": 219.13, "additional_payer_notes": "177.30% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ PPO", "methodology": "fee schedule", "standard_charge_dollar": 219.13, "additional_payer_notes": "177.30% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon Medicare", "methodology": "fee schedule", "standard_charge_dollar": 123.59, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Military Tricare", "methodology": "fee schedule", "standard_charge_dollar": 98.87, "additional_payer_notes": "80.00% of Medicare Rates" }, { "payer_name": "Keenan", "plan_name": "Keenan", "methodology": "percent of total billed charges", "standard_charge_percentage": 30.0, "median_amount": 168.77, "10th_percentile": 168.77, "90th_percentile": 168.77, "count": "1 through 10" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 123.59, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 123.59, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC All Payer (02-01-2023 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 163.46 }, { "payer_name": "UHC", "plan_name": "UHC Medicaid (02/01/2023 to 12-31-2026)", "methodology": "percent of total billed charges", "standard_charge_percentage": 19.47, "median_amount": 107.02, "10th_percentile": 107.02, "90th_percentile": 109.54, "count": "1 through 10" }, { "payer_name": "UHC", "plan_name": "UHC Oxford (02-01-2023 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 163.46 }, { "payer_name": "UHC - Adhoc", "plan_name": "UHC - Adhoc All Payer", "methodology": "fee schedule", "standard_charge_dollar": 108.97 }, { "payer_name": "UHC - Adhoc", "plan_name": "UHC - Adhoc Oxford", "methodology": "fee schedule", "standard_charge_dollar": 108.97 }, { "payer_name": "Wellcare", "plan_name": "Wellcare Insurance Exchange", "methodology": "fee schedule", "standard_charge_dollar": 166.85, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 123.59, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup Medicaid", "methodology": "percent of total billed charges", "standard_charge_percentage": 19.09, "median_amount": 104.92, "10th_percentile": 104.92, "90th_percentile": 104.92, "count": "1 through 10" }, { "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup Medicare", "methodology": "fee schedule", "standard_charge_dollar": 123.59, "additional_payer_notes": "100.00% of Medicare Rates" } ] } ] }, { "description": "Hc Us Fetal Hrt Doppl F/U", "code_information": [ { "code": "76828", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 179.0, "discounted_cash": 123.0, "minimum": 34.1711, "maximum": 179.0, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 179.0, "additional_payer_notes": "212.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medical Rental Network", "methodology": "fee schedule", "standard_charge_dollar": 179.0, "additional_payer_notes": "212.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 123.59, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "ALLY-ALIGN (FKA SPARTAN PLAN NJ, INC.)", "plan_name": "ALLY-ALIGN (FKA SPARTAN PLAN NJ, INC.)", "methodology": "fee schedule", "standard_charge_dollar": 129.77, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Americhoice (UHC)", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 123.59, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Amerihealth", "plan_name": "Amerihealth HMO", "methodology": "fee schedule", "standard_charge_dollar": 54.81 }, { "payer_name": "Amerihealth", "plan_name": "Amerihealth Medicare", "methodology": "fee schedule", "standard_charge_dollar": 123.59, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 179.0, "additional_payer_notes": "146.95% of Medicare Rates" }, { "payer_name": "Clover Health", "plan_name": "Clover Medicare", "methodology": "fee schedule", "standard_charge_dollar": 123.59, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Coventry", "plan_name": "Coventry Auto", "methodology": "fee schedule", "standard_charge_dollar": 179.0, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Coventry", "plan_name": "Coventry Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 179.0, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "fee schedule", "standard_charge_dollar": 173.03, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Fairprice Healthcare Holdings", "plan_name": "Fairprice Healthcare Holdings", "methodology": "fee schedule", "standard_charge_dollar": 179.0, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ HMO POS", "methodology": "fee schedule", "standard_charge_dollar": 179.0, "additional_payer_notes": "177.30% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ Indemnity", "methodology": "fee schedule", "standard_charge_dollar": 179.0, "additional_payer_notes": "177.30% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ PPO", "methodology": "fee schedule", "standard_charge_dollar": 179.0, "additional_payer_notes": "177.30% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon Medicare", "methodology": "fee schedule", "standard_charge_dollar": 123.59, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Military Tricare", "methodology": "fee schedule", "standard_charge_dollar": 98.87, "additional_payer_notes": "80.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 123.59, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 123.59, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC All Payer (02-01-2023 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 163.46 }, { "payer_name": "UHC", "plan_name": "UHC Oxford (02-01-2023 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 163.46 }, { "payer_name": "UHC - Adhoc", "plan_name": "UHC - Adhoc All Payer", "methodology": "fee schedule", "standard_charge_dollar": 108.97 }, { "payer_name": "UHC - Adhoc", "plan_name": "UHC - Adhoc Oxford", "methodology": "fee schedule", "standard_charge_dollar": 108.97 }, { "payer_name": "Wellcare", "plan_name": "Wellcare Insurance Exchange", "methodology": "fee schedule", "standard_charge_dollar": 166.85, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 123.59, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup Medicare", "methodology": "fee schedule", "standard_charge_dollar": 123.59, "additional_payer_notes": "100.00% of Medicare Rates" } ] } ] }, { "description": "EXTRACRANIAL PROCEDURES WITHOUT CCMCC", "code_information": [ { "code": "039", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 15141.0, "minimum": 7071.08, "maximum": 27405.8435, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "case rate", "standard_charge_dollar": 27405.84, "additional_payer_notes": "181.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medical Rental Network", "methodology": "case rate", "standard_charge_dollar": 27405.84, "additional_payer_notes": "181.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "case rate", "standard_charge_dollar": 12464.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "ALLY-ALIGN (FKA SPARTAN PLAN NJ, INC.)", "plan_name": "ALLY-ALIGN (FKA SPARTAN PLAN NJ, INC.)", "methodology": "case rate", "standard_charge_dollar": 15898.42, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Americhoice (UHC)", "plan_name": "UHC Medicare", "methodology": "case rate", "standard_charge_dollar": 12464.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Amerihealth", "plan_name": "Amerihealth Medicare", "methodology": "case rate", "standard_charge_dollar": 12464.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Commercial", "methodology": "case rate", "standard_charge_dollar": 17197.57 }, { "payer_name": "Clover Health", "plan_name": "Clover Medicare", "methodology": "case rate", "standard_charge_dollar": 12464.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Coventry", "plan_name": "Coventry Auto", "methodology": "case rate", "standard_charge_dollar": 25740.3, "additional_payer_notes": "170.00% of Medicare Rates" }, { "payer_name": "Coventry", "plan_name": "Coventry Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 25740.3, "additional_payer_notes": "170.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "case rate", "standard_charge_dollar": 19683.76, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Fairprice Healthcare Holdings", "plan_name": "Fairprice Healthcare Holdings", "methodology": "case rate", "standard_charge_dollar": 24226.16, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon Medicare", "methodology": "case rate", "standard_charge_dollar": 12464.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon NJ Health Medicaid", "methodology": "case rate", "standard_charge_dollar": 7071.08 }, { "payer_name": "Humana", "plan_name": "Humana Military Tricare", "methodology": "case rate", "standard_charge_dollar": 12113.08, "additional_payer_notes": "80.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 15141.35, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 21459.0 }, { "payer_name": "UBH", "plan_name": "UBH Medicare", "methodology": "case rate", "standard_charge_dollar": 12464.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC All Payer (02-01-2023 to 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 19814.23 }, { "payer_name": "UHC", "plan_name": "UHC Oxford (02-01-2023 to 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 17268.1 }, { "payer_name": "UHC - Adhoc", "plan_name": "UHC - Adhoc All Payer", "methodology": "case rate", "standard_charge_dollar": 21033.22 }, { "payer_name": "UHC - Adhoc", "plan_name": "UHC - Adhoc Oxford", "methodology": "case rate", "standard_charge_dollar": 17794.72 }, { "payer_name": "Wellcare", "plan_name": "Wellcare Insurance Exchange", "methodology": "case rate", "standard_charge_dollar": 20440.82, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "case rate", "standard_charge_dollar": 12464.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup Medicare", "methodology": "case rate", "standard_charge_dollar": 12464.8, "additional_payer_notes": "100.00% of Medicare Rates" } ] } ] }, { "description": "Hc Immunoglobulin Light Chains Free Each", "code_information": [ { "code": "83521", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 61.31, "discounted_cash": 17.0, "minimum": 10.36, "maximum": 52.1135, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 36.61, "additional_payer_notes": "212.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medical Rental Network", "methodology": "fee schedule", "standard_charge_dollar": 36.61, "additional_payer_notes": "212.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 17.27, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "ALLY-ALIGN (FKA SPARTAN PLAN NJ, INC.)", "plan_name": "ALLY-ALIGN (FKA SPARTAN PLAN NJ, INC.)", "methodology": "fee schedule", "standard_charge_dollar": 18.13, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Americhoice (UHC)", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 17.27, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Amerihealth", "plan_name": "Amerihealth Medicare", "methodology": "fee schedule", "standard_charge_dollar": 17.27, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 25.04, "additional_payer_notes": "Laboratory - 145.00% of Medicare Rates" }, { "payer_name": "Clover Health", "plan_name": "Clover Medicare", "methodology": "fee schedule", "standard_charge_dollar": 17.27, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Coventry", "plan_name": "Coventry Auto", "methodology": "fee schedule", "standard_charge_dollar": 34.54, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Coventry", "plan_name": "Coventry Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 34.54, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "fee schedule", "standard_charge_dollar": 24.18, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Fairprice Healthcare Holdings", "plan_name": "Fairprice Healthcare Holdings", "methodology": "fee schedule", "standard_charge_dollar": 20.72, "additional_payer_notes": "Laboratory - 120.00% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ HMO POS", "methodology": "fee schedule", "standard_charge_dollar": 43.28, "additional_payer_notes": "177.30% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ Indemnity", "methodology": "fee schedule", "standard_charge_dollar": 43.28, "additional_payer_notes": "177.30% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ PPO", "methodology": "fee schedule", "standard_charge_dollar": 43.28, "additional_payer_notes": "177.30% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon Medicare", "methodology": "fee schedule", "standard_charge_dollar": 17.27, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Military Tricare", "methodology": "fee schedule", "standard_charge_dollar": 13.82, "additional_payer_notes": "80.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 17.27, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 17.27, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC All Payer (02-01-2023 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 10.36 }, { "payer_name": "UHC", "plan_name": "UHC Medicaid (02/01/2023 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 13.82 }, { "payer_name": "UHC", "plan_name": "UHC Oxford (02-01-2023 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 10.36 }, { "payer_name": "UHC - Adhoc", "plan_name": "UHC - Adhoc All Payer", "methodology": "fee schedule", "standard_charge_dollar": 17.27 }, { "payer_name": "UHC - Adhoc", "plan_name": "UHC - Adhoc Oxford", "methodology": "fee schedule", "standard_charge_dollar": 17.27 }, { "payer_name": "Wellcare", "plan_name": "Wellcare Insurance Exchange", "methodology": "fee schedule", "standard_charge_dollar": 23.31, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 17.27, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup Medicare", "methodology": "fee schedule", "standard_charge_dollar": 17.27, "additional_payer_notes": "100.00% of Medicare Rates" } ] } ] }, { "description": "Unlisted Px Ant Segment Eye", "code_information": [ { "code": "66999", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 17310.0, "discounted_cash": 2728.0, "minimum": 1715.0, "maximum": 13848.0, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 5784.04, "additional_payer_notes": "212.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medical Rental Network", "methodology": "fee schedule", "standard_charge_dollar": 5784.04, "additional_payer_notes": "212.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2728.32, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "ALLY-ALIGN (FKA SPARTAN PLAN NJ, INC.)", "plan_name": "ALLY-ALIGN (FKA SPARTAN PLAN NJ, INC.)", "methodology": "fee schedule", "standard_charge_dollar": 2864.74, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Americhoice (UHC)", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2728.32, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Amerihealth", "plan_name": "Amerihealth Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2728.32, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 4009.27, "additional_payer_notes": "146.95% of Medicare Rates" }, { "payer_name": "Clover Health", "plan_name": "Clover Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2728.32, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Coventry", "plan_name": "Coventry Auto", "methodology": "fee schedule", "standard_charge_dollar": 5456.64, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Coventry", "plan_name": "Coventry Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 5456.64, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "fee schedule", "standard_charge_dollar": 3819.65, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Fairprice Healthcare Holdings", "plan_name": "Fairprice Healthcare Holdings", "methodology": "fee schedule", "standard_charge_dollar": 4365.31, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ HMO POS", "methodology": "fee schedule", "standard_charge_dollar": 4837.31, "additional_payer_notes": "177.30% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ Indemnity", "methodology": "fee schedule", "standard_charge_dollar": 4837.31, "additional_payer_notes": "177.30% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ PPO", "methodology": "fee schedule", "standard_charge_dollar": 4837.31, "additional_payer_notes": "177.30% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2728.32, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Military Tricare", "methodology": "fee schedule", "standard_charge_dollar": 2182.66, "additional_payer_notes": "80.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2728.32, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 2728.32, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC All Payer (02-01-2023 to 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 3912.0 }, { "payer_name": "UHC", "plan_name": "UHC Oxford (02-01-2023 to 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 3676.0 }, { "payer_name": "UHC - Adhoc", "plan_name": "UHC - Adhoc All Payer", "methodology": "case rate", "standard_charge_dollar": 4153.0 }, { "payer_name": "UHC - Adhoc", "plan_name": "UHC - Adhoc Oxford", "methodology": "case rate", "standard_charge_dollar": 3788.0 }, { "payer_name": "Wellcare", "plan_name": "Wellcare Insurance Exchange", "methodology": "fee schedule", "standard_charge_dollar": 3683.23, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2728.32, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellchoice", "plan_name": "WELLCHOICE HMO of NJ (Empire) Commercial (HMO / HMO POS, PPO)", "methodology": "case rate", "standard_charge_dollar": 1715.0 }, { "payer_name": "Wellchoice", "plan_name": "WELLCHOICE HMO of NJ (Empire) Commercial (Indemnity)", "methodology": "case rate", "standard_charge_dollar": 1978.0 }, { "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2728.32, "additional_payer_notes": "100.00% of Medicare Rates" } ] } ] }, { "description": "Hc Repr Wnd Smp Face >30.1 Cm", "code_information": [ { "code": "12018", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 657.7, "discounted_cash": 237.0, "minimum": 125.5549, "maximum": 657.7, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 502.82, "additional_payer_notes": "212.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medical Rental Network", "methodology": "fee schedule", "standard_charge_dollar": 502.82, "additional_payer_notes": "212.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 237.18, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "ALLY-ALIGN (FKA SPARTAN PLAN NJ, INC.)", "plan_name": "ALLY-ALIGN (FKA SPARTAN PLAN NJ, INC.)", "methodology": "fee schedule", "standard_charge_dollar": 249.04, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Americhoice (UHC)", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 237.18, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Amerihealth", "plan_name": "Amerihealth Medicare", "methodology": "fee schedule", "standard_charge_dollar": 237.18, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 348.54, "additional_payer_notes": "146.95% of Medicare Rates" }, { "payer_name": "Clover Health", "plan_name": "Clover Medicare", "methodology": "fee schedule", "standard_charge_dollar": 237.18, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Coventry", "plan_name": "Coventry Auto", "methodology": "fee schedule", "standard_charge_dollar": 474.36, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Coventry", "plan_name": "Coventry Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 474.36, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "fee schedule", "standard_charge_dollar": 332.05, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Fairprice Healthcare Holdings", "plan_name": "Fairprice Healthcare Holdings", "methodology": "fee schedule", "standard_charge_dollar": 379.49, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ HMO POS", "methodology": "fee schedule", "standard_charge_dollar": 420.52, "additional_payer_notes": "177.30% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ Indemnity", "methodology": "fee schedule", "standard_charge_dollar": 420.52, "additional_payer_notes": "177.30% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ PPO", "methodology": "fee schedule", "standard_charge_dollar": 420.52, "additional_payer_notes": "177.30% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon Medicare", "methodology": "fee schedule", "standard_charge_dollar": 237.18, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Military Tricare", "methodology": "fee schedule", "standard_charge_dollar": 189.74, "additional_payer_notes": "80.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 237.18, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 237.18, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC All Payer (02-01-2023 to 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 657.7 }, { "payer_name": "UHC", "plan_name": "UHC Oxford (02-01-2023 to 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 657.7 }, { "payer_name": "UHC - Adhoc", "plan_name": "UHC - Adhoc All Payer", "methodology": "case rate", "standard_charge_dollar": 657.7 }, { "payer_name": "UHC - Adhoc", "plan_name": "UHC - Adhoc Oxford", "methodology": "case rate", "standard_charge_dollar": 657.7 }, { "payer_name": "Wellcare", "plan_name": "Wellcare Insurance Exchange", "methodology": "fee schedule", "standard_charge_dollar": 320.19, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 237.18, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellchoice", "plan_name": "WELLCHOICE HMO of NJ (Empire) Commercial (HMO / HMO POS, PPO)", "methodology": "case rate", "standard_charge_dollar": 657.7 }, { "payer_name": "Wellchoice", "plan_name": "WELLCHOICE HMO of NJ (Empire) Commercial (Indemnity)", "methodology": "case rate", "standard_charge_dollar": 657.7 }, { "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup Medicare", "methodology": "fee schedule", "standard_charge_dollar": 237.18, "additional_payer_notes": "100.00% of Medicare Rates" } ] } ] }, { "description": "OTHER INJURY, POISONING AND TOXIC EFFECT DIAGNOSES WITH MCC", "code_information": [ { "code": "922", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 21773.0, "minimum": 9731.17, "maximum": 39410.2341, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "case rate", "standard_charge_dollar": 39410.23, "additional_payer_notes": "181.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medical Rental Network", "methodology": "case rate", "standard_charge_dollar": 39410.23, "additional_payer_notes": "181.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "case rate", "standard_charge_dollar": 17790.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "ALLY-ALIGN (FKA SPARTAN PLAN NJ, INC.)", "plan_name": "ALLY-ALIGN (FKA SPARTAN PLAN NJ, INC.)", "methodology": "case rate", "standard_charge_dollar": 22862.29, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Americhoice (UHC)", "plan_name": "UHC Medicare", "methodology": "case rate", "standard_charge_dollar": 17790.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Amerihealth", "plan_name": "Amerihealth Medicare", "methodology": "case rate", "standard_charge_dollar": 17790.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Commercial", "methodology": "case rate", "standard_charge_dollar": 25593.72 }, { "payer_name": "Clover Health", "plan_name": "Clover Medicare", "methodology": "case rate", "standard_charge_dollar": 17790.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Coventry", "plan_name": "Coventry Auto", "methodology": "case rate", "standard_charge_dollar": 37015.14, "additional_payer_notes": "170.00% of Medicare Rates" }, { "payer_name": "Coventry", "plan_name": "Coventry Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 37015.14, "additional_payer_notes": "170.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "case rate", "standard_charge_dollar": 28305.69, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Fairprice Healthcare Holdings", "plan_name": "Fairprice Healthcare Holdings", "methodology": "case rate", "standard_charge_dollar": 34837.78, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon Medicare", "methodology": "case rate", "standard_charge_dollar": 17790.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon NJ Health Medicaid", "methodology": "case rate", "standard_charge_dollar": 9731.17 }, { "payer_name": "Humana", "plan_name": "Humana Military Tricare", "methodology": "case rate", "standard_charge_dollar": 17418.89, "additional_payer_notes": "80.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 21773.61, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 22592.7 }, { "payer_name": "UBH", "plan_name": "UBH Medicare", "methodology": "case rate", "standard_charge_dollar": 17790.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC All Payer (02-01-2023 to 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 29487.89 }, { "payer_name": "UHC", "plan_name": "UHC Oxford (02-01-2023 to 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 25698.69 }, { "payer_name": "UHC - Adhoc", "plan_name": "UHC - Adhoc All Payer", "methodology": "case rate", "standard_charge_dollar": 31302.01 }, { "payer_name": "UHC - Adhoc", "plan_name": "UHC - Adhoc Oxford", "methodology": "case rate", "standard_charge_dollar": 26482.42 }, { "payer_name": "Wellcare", "plan_name": "Wellcare Insurance Exchange", "methodology": "case rate", "standard_charge_dollar": 29394.37, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "case rate", "standard_charge_dollar": 17790.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup Medicare", "methodology": "case rate", "standard_charge_dollar": 17790.3, "additional_payer_notes": "100.00% of Medicare Rates" } ] } ] }, { "description": "TONSIL & ADENOID PROCEDURES - SOI : 1", "code_information": [ { "code": "0971", "type": "APR-DRG" } ], "standard_charges": [ { "setting": "inpatient", "minimum": 6817.65, "maximum": 7499.42, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Better Health - Medi Medi", "methodology": "case rate", "standard_charge_dollar": 7499.42, "additional_payer_notes": "110% of State Medicaid Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Better Health Medicaid", "methodology": "case rate", "standard_charge_dollar": 7499.42, "additional_payer_notes": "110% of State Medicaid Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "case rate", "standard_charge_dollar": 6817.65, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "UBH", "plan_name": "UBH Medicaid", "methodology": "case rate", "standard_charge_dollar": 6817.65, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicaid (02/01/2023 to 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 6954.0, "additional_payer_notes": "102% of State Medicaid Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicaid", "methodology": "case rate", "standard_charge_dollar": 6817.65, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup Medicaid", "methodology": "case rate", "standard_charge_dollar": 6817.65, "additional_payer_notes": "100% of State Medicaid Rates" } ] } ] }, { "description": "AMPUTATION FOR CIRCULATORY SYSTEM DISORDERS EXCEPT UPPER LIMB AND TOE WITH MCC", "code_information": [ { "code": "239", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 58434.0, "minimum": 29406.44, "maximum": 105765.902, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "case rate", "standard_charge_dollar": 105765.9, "additional_payer_notes": "181.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medical Rental Network", "methodology": "case rate", "standard_charge_dollar": 105765.9, "additional_payer_notes": "181.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "case rate", "standard_charge_dollar": 47227.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "ALLY-ALIGN (FKA SPARTAN PLAN NJ, INC.)", "plan_name": "ALLY-ALIGN (FKA SPARTAN PLAN NJ, INC.)", "methodology": "case rate", "standard_charge_dollar": 61355.91, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Americhoice (UHC)", "plan_name": "UHC Medicare", "methodology": "case rate", "standard_charge_dollar": 47227.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Amerihealth", "plan_name": "Amerihealth Medicare", "methodology": "case rate", "standard_charge_dollar": 47227.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Commercial", "methodology": "case rate", "standard_charge_dollar": 72004.47 }, { "payer_name": "Clover Health", "plan_name": "Clover Medicare", "methodology": "case rate", "standard_charge_dollar": 47227.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Coventry", "plan_name": "Coventry Auto", "methodology": "case rate", "standard_charge_dollar": 99338.14, "additional_payer_notes": "170.00% of Medicare Rates" }, { "payer_name": "Coventry", "plan_name": "Coventry Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 99338.14, "additional_payer_notes": "170.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "case rate", "standard_charge_dollar": 75964.46, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Fairprice Healthcare Holdings", "plan_name": "Fairprice Healthcare Holdings", "methodology": "case rate", "standard_charge_dollar": 93494.72, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon Medicare", "methodology": "case rate", "standard_charge_dollar": 47227.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon NJ Health Medicaid", "methodology": "case rate", "standard_charge_dollar": 29406.44 }, { "payer_name": "Humana", "plan_name": "Humana Military Tricare", "methodology": "case rate", "standard_charge_dollar": 46747.36, "additional_payer_notes": "80.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 58434.2, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 51870.1 }, { "payer_name": "UBH", "plan_name": "UBH Medicare", "methodology": "case rate", "standard_charge_dollar": 47227.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC All Payer (02-01-2023 to 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 82960.18 }, { "payer_name": "UHC", "plan_name": "UHC Oxford (02-01-2023 to 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 72299.77 }, { "payer_name": "UHC - Adhoc", "plan_name": "UHC - Adhoc All Payer", "methodology": "case rate", "standard_charge_dollar": 88063.98 }, { "payer_name": "UHC - Adhoc", "plan_name": "UHC - Adhoc Oxford", "methodology": "case rate", "standard_charge_dollar": 74504.69 }, { "payer_name": "Wellcare", "plan_name": "Wellcare Insurance Exchange", "methodology": "case rate", "standard_charge_dollar": 78886.17, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "case rate", "standard_charge_dollar": 47227.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup Medicare", "methodology": "case rate", "standard_charge_dollar": 47227.8, "additional_payer_notes": "100.00% of Medicare Rates" } ] } ] }, { "description": "OTHER & UNSPECIFIED GASTROINTESTINAL HEMORRHAGE - SOI : 1", "code_information": [ { "code": "2531", "type": "APR-DRG" } ], "standard_charges": [ { "setting": "inpatient", "minimum": 7172.18, "maximum": 7889.4, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Better Health - Medi Medi", "methodology": "case rate", "standard_charge_dollar": 7889.4, "additional_payer_notes": "110% of State Medicaid Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Better Health Medicaid", "methodology": "case rate", "standard_charge_dollar": 7889.4, "additional_payer_notes": "110% of State Medicaid Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "case rate", "standard_charge_dollar": 7172.18, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "UBH", "plan_name": "UBH Medicaid", "methodology": "case rate", "standard_charge_dollar": 7172.18, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicaid (02/01/2023 to 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 7315.63, "additional_payer_notes": "102% of State Medicaid Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicaid", "methodology": "case rate", "standard_charge_dollar": 7172.18, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup Medicaid", "methodology": "case rate", "standard_charge_dollar": 7172.18, "additional_payer_notes": "100% of State Medicaid Rates" } ] } ] }, { "description": "SCHIZOPHRENIA - SOI : 2", "code_information": [ { "code": "7502", "type": "APR-DRG" } ], "standard_charges": [ { "setting": "inpatient", "minimum": 8383.84, "maximum": 9222.22, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Better Health - Medi Medi", "methodology": "case rate", "standard_charge_dollar": 9222.22, "additional_payer_notes": "110% of State Medicaid Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Better Health Medicaid", "methodology": "case rate", "standard_charge_dollar": 9222.22, "additional_payer_notes": "110% of State Medicaid Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "case rate", "standard_charge_dollar": 8383.84, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "UBH", "plan_name": "UBH Medicaid", "methodology": "case rate", "standard_charge_dollar": 8383.84, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicaid (02/01/2023 to 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 8551.52, "additional_payer_notes": "102% of State Medicaid Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicaid", "methodology": "case rate", "standard_charge_dollar": 8383.84, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup Medicaid", "methodology": "case rate", "standard_charge_dollar": 8383.84, "additional_payer_notes": "100% of State Medicaid Rates" } ] } ] }, { "description": "Hc Bx Breast W Device Mri Guide 1St Lesion", "code_information": [ { "code": "19085", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 806.42, "discounted_cash": 1952.0, "minimum": 153.9456, "maximum": 806.42, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 806.42, "additional_payer_notes": "212.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medical Rental Network", "methodology": "fee schedule", "standard_charge_dollar": 806.42, "additional_payer_notes": "212.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 806.42, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "ALLY-ALIGN (FKA SPARTAN PLAN NJ, INC.)", "plan_name": "ALLY-ALIGN (FKA SPARTAN PLAN NJ, INC.)", "methodology": "fee schedule", "standard_charge_dollar": 806.42, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Americhoice (UHC)", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 806.42, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Amerihealth", "plan_name": "Amerihealth Medicare", "methodology": "fee schedule", "standard_charge_dollar": 806.42, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 806.42, "additional_payer_notes": "146.95% of Medicare Rates" }, { "payer_name": "Clover Health", "plan_name": "Clover Medicare", "methodology": "fee schedule", "standard_charge_dollar": 806.42, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Coventry", "plan_name": "Coventry Auto", "methodology": "fee schedule", "standard_charge_dollar": 806.42, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Coventry", "plan_name": "Coventry Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 806.42, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "fee schedule", "standard_charge_dollar": 806.42, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Fairprice Healthcare Holdings", "plan_name": "Fairprice Healthcare Holdings", "methodology": "fee schedule", "standard_charge_dollar": 806.42, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ HMO POS", "methodology": "fee schedule", "standard_charge_dollar": 806.42, "additional_payer_notes": "177.30% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ Indemnity", "methodology": "fee schedule", "standard_charge_dollar": 806.42, "additional_payer_notes": "177.30% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ PPO", "methodology": "fee schedule", "standard_charge_dollar": 806.42, "additional_payer_notes": "177.30% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon Medicare", "methodology": "fee schedule", "standard_charge_dollar": 806.42, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Military Tricare", "methodology": "fee schedule", "standard_charge_dollar": 806.42, "additional_payer_notes": "80.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 806.42, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 806.42, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC All Payer (02-01-2023 to 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 806.42 }, { "payer_name": "UHC", "plan_name": "UHC Oxford (02-01-2023 to 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 806.42 }, { "payer_name": "UHC - Adhoc", "plan_name": "UHC - Adhoc All Payer", "methodology": "case rate", "standard_charge_dollar": 806.42 }, { "payer_name": "UHC - Adhoc", "plan_name": "UHC - Adhoc Oxford", "methodology": "case rate", "standard_charge_dollar": 806.42 }, { "payer_name": "Wellcare", "plan_name": "Wellcare Insurance Exchange", "methodology": "fee schedule", "standard_charge_dollar": 806.42, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 806.42, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup Medicare", "methodology": "fee schedule", "standard_charge_dollar": 806.42, "additional_payer_notes": "100.00% of Medicare Rates" } ] } ] }, { "description": "Hc I&D Arm/Elbow Infect Bursa", "code_information": [ { "code": "23931", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 5127.07, "discounted_cash": 1952.0, "minimum": 978.7577, "maximum": 4153.0, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 4139.36, "additional_payer_notes": "212.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medical Rental Network", "methodology": "fee schedule", "standard_charge_dollar": 4139.36, "additional_payer_notes": "212.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1952.53, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "ALLY-ALIGN (FKA SPARTAN PLAN NJ, INC.)", "plan_name": "ALLY-ALIGN (FKA SPARTAN PLAN NJ, INC.)", "methodology": "fee schedule", "standard_charge_dollar": 2050.16, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Americhoice (UHC)", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1952.53, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Amerihealth", "plan_name": "Amerihealth Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1952.53, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 2869.24, "additional_payer_notes": "146.95% of Medicare Rates" }, { "payer_name": "Clover Health", "plan_name": "Clover Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1952.53, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Coventry", "plan_name": "Coventry Auto", "methodology": "fee schedule", "standard_charge_dollar": 3905.06, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Coventry", "plan_name": "Coventry Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 3905.06, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "fee schedule", "standard_charge_dollar": 2733.54, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Fairprice Healthcare Holdings", "plan_name": "Fairprice Healthcare Holdings", "methodology": "fee schedule", "standard_charge_dollar": 3124.05, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ HMO POS", "methodology": "fee schedule", "standard_charge_dollar": 3461.84, "additional_payer_notes": "177.30% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ Indemnity", "methodology": "fee schedule", "standard_charge_dollar": 3461.84, "additional_payer_notes": "177.30% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ PPO", "methodology": "fee schedule", "standard_charge_dollar": 3461.84, "additional_payer_notes": "177.30% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1952.53, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Military Tricare", "methodology": "fee schedule", "standard_charge_dollar": 1562.02, "additional_payer_notes": "80.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1952.53, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 1952.53, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC All Payer (02-01-2023 to 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 3912.0 }, { "payer_name": "UHC", "plan_name": "UHC Oxford (02-01-2023 to 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 3676.0 }, { "payer_name": "UHC - Adhoc", "plan_name": "UHC - Adhoc All Payer", "methodology": "case rate", "standard_charge_dollar": 4153.0 }, { "payer_name": "UHC - Adhoc", "plan_name": "UHC - Adhoc Oxford", "methodology": "case rate", "standard_charge_dollar": 3788.0 }, { "payer_name": "Wellcare", "plan_name": "Wellcare Insurance Exchange", "methodology": "fee schedule", "standard_charge_dollar": 2635.92, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1952.53, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellchoice", "plan_name": "WELLCHOICE HMO of NJ (Empire) Commercial (HMO / HMO POS, PPO)", "methodology": "case rate", "standard_charge_dollar": 1715.0 }, { "payer_name": "Wellchoice", "plan_name": "WELLCHOICE HMO of NJ (Empire) Commercial (Indemnity)", "methodology": "case rate", "standard_charge_dollar": 1978.0 }, { "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1952.53, "additional_payer_notes": "100.00% of Medicare Rates" } ] } ] }, { "description": "Hc Culture, Chlamydia", "code_information": [ { "code": "87110", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 104.0, "discounted_cash": 19.0, "minimum": 11.76, "maximum": 88.4, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 41.55, "additional_payer_notes": "212.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medical Rental Network", "methodology": "fee schedule", "standard_charge_dollar": 41.55, "additional_payer_notes": "212.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 19.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "ALLY-ALIGN (FKA SPARTAN PLAN NJ, INC.)", "plan_name": "ALLY-ALIGN (FKA SPARTAN PLAN NJ, INC.)", "methodology": "fee schedule", "standard_charge_dollar": 20.58, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Americhoice (UHC)", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 19.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Amerihealth", "plan_name": "Amerihealth Medicare", "methodology": "fee schedule", "standard_charge_dollar": 19.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 28.42, "additional_payer_notes": "A Indicator - 155.00% of Medicare Rates" }, { "payer_name": "Clover Health", "plan_name": "Clover Medicare", "methodology": "fee schedule", "standard_charge_dollar": 19.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Coventry", "plan_name": "Coventry Auto", "methodology": "fee schedule", "standard_charge_dollar": 39.2, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Coventry", "plan_name": "Coventry Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 39.2, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "fee schedule", "standard_charge_dollar": 27.44, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Fairprice Healthcare Holdings", "plan_name": "Fairprice Healthcare Holdings", "methodology": "fee schedule", "standard_charge_dollar": 23.52, "additional_payer_notes": "Laboratory - 120.00% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ HMO POS", "methodology": "fee schedule", "standard_charge_dollar": 73.42, "additional_payer_notes": "177.30% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ Indemnity", "methodology": "fee schedule", "standard_charge_dollar": 73.42, "additional_payer_notes": "177.30% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ PPO", "methodology": "fee schedule", "standard_charge_dollar": 73.42, "additional_payer_notes": "177.30% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon Medicare", "methodology": "fee schedule", "standard_charge_dollar": 19.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Military Tricare", "methodology": "fee schedule", "standard_charge_dollar": 15.68, "additional_payer_notes": "80.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 19.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 19.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC All Payer (02-01-2023 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 11.76 }, { "payer_name": "UHC", "plan_name": "UHC Medicaid (02/01/2023 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 15.68 }, { "payer_name": "UHC", "plan_name": "UHC Oxford (02-01-2023 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 11.76 }, { "payer_name": "UHC - Adhoc", "plan_name": "UHC - Adhoc All Payer", "methodology": "fee schedule", "standard_charge_dollar": 19.6 }, { "payer_name": "UHC - Adhoc", "plan_name": "UHC - Adhoc Oxford", "methodology": "fee schedule", "standard_charge_dollar": 19.6 }, { "payer_name": "Wellcare", "plan_name": "Wellcare Insurance Exchange", "methodology": "fee schedule", "standard_charge_dollar": 26.46, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 19.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup Medicare", "methodology": "fee schedule", "standard_charge_dollar": 19.6, "additional_payer_notes": "100.00% of Medicare Rates" } ] } ] }, { "description": "OTHER DIGESTIVE SYSTEM DIAGNOSES - SOI : 4", "code_information": [ { "code": "2544", "type": "APR-DRG" } ], "standard_charges": [ { "setting": "inpatient", "minimum": 21632.48, "maximum": 23795.72, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Better Health - Medi Medi", "methodology": "case rate", "standard_charge_dollar": 23795.72, "additional_payer_notes": "110% of State Medicaid Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Better Health Medicaid", "methodology": "case rate", "standard_charge_dollar": 23795.72, "additional_payer_notes": "110% of State Medicaid Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "case rate", "standard_charge_dollar": 21632.48, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "UBH", "plan_name": "UBH Medicaid", "methodology": "case rate", "standard_charge_dollar": 21632.48, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicaid (02/01/2023 to 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 22065.13, "additional_payer_notes": "102% of State Medicaid Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicaid", "methodology": "case rate", "standard_charge_dollar": 21632.48, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup Medicaid", "methodology": "case rate", "standard_charge_dollar": 21632.48, "additional_payer_notes": "100% of State Medicaid Rates" } ] } ] }, { "description": "Hc X-Ray Nasal Bones", "code_information": [ { "code": "70160", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 427.63, "discounted_cash": 102.0, "minimum": 54.81, "maximum": 363.4855, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 218.08, "additional_payer_notes": "212.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medical Rental Network", "methodology": "fee schedule", "standard_charge_dollar": 218.08, "additional_payer_notes": "212.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 102.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "ALLY-ALIGN (FKA SPARTAN PLAN NJ, INC.)", "plan_name": "ALLY-ALIGN (FKA SPARTAN PLAN NJ, INC.)", "methodology": "fee schedule", "standard_charge_dollar": 108.01, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Americhoice (UHC)", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 102.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Amerihealth", "plan_name": "Amerihealth HMO", "methodology": "fee schedule", "standard_charge_dollar": 54.81 }, { "payer_name": "Amerihealth", "plan_name": "Amerihealth Medicare", "methodology": "fee schedule", "standard_charge_dollar": 102.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 151.17, "additional_payer_notes": "146.95% of Medicare Rates" }, { "payer_name": "Clover Health", "plan_name": "Clover Medicare", "methodology": "fee schedule", "standard_charge_dollar": 102.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Coventry", "plan_name": "Coventry Auto", "methodology": "fee schedule", "standard_charge_dollar": 205.74, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Coventry", "plan_name": "Coventry Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 205.74, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "fee schedule", "standard_charge_dollar": 144.02, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Fairprice Healthcare Holdings", "plan_name": "Fairprice Healthcare Holdings", "methodology": "fee schedule", "standard_charge_dollar": 164.59, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ HMO POS", "methodology": "fee schedule", "standard_charge_dollar": 182.39, "additional_payer_notes": "177.30% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ Indemnity", "methodology": "fee schedule", "standard_charge_dollar": 182.39, "additional_payer_notes": "177.30% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ PPO", "methodology": "fee schedule", "standard_charge_dollar": 182.39, "additional_payer_notes": "177.30% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon Medicare", "methodology": "fee schedule", "standard_charge_dollar": 102.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon NJ Health Medicaid", "methodology": "percent of total billed charges", "standard_charge_percentage": 19.58, "median_amount": 83.73, "10th_percentile": 83.73, "90th_percentile": 83.73, "count": "1 through 10" }, { "payer_name": "Humana", "plan_name": "Humana Military Tricare", "methodology": "fee schedule", "standard_charge_dollar": 82.3, "additional_payer_notes": "80.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 102.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 102.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC All Payer (02-01-2023 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 121.35 }, { "payer_name": "UHC", "plan_name": "UHC Oxford (02-01-2023 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 121.35 }, { "payer_name": "UHC - Adhoc", "plan_name": "UHC - Adhoc All Payer", "methodology": "fee schedule", "standard_charge_dollar": 80.9 }, { "payer_name": "UHC - Adhoc", "plan_name": "UHC - Adhoc Oxford", "methodology": "fee schedule", "standard_charge_dollar": 80.9 }, { "payer_name": "Wellcare", "plan_name": "Wellcare Insurance Exchange", "methodology": "fee schedule", "standard_charge_dollar": 138.87, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 102.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup Medicare", "methodology": "fee schedule", "standard_charge_dollar": 102.87, "additional_payer_notes": "100.00% of Medicare Rates" } ] } ] }, { "description": "Hc Mthfr Gene", "code_information": [ { "code": "81291", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 231.96, "discounted_cash": 65.0, "minimum": 39.2, "maximum": 197.166, "payers_information": [ { "payer_name": "Wellcare", "plan_name": "Wellcare Insurance Exchange", "methodology": "fee schedule", "standard_charge_dollar": 88.21, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 65.34, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup Medicare", "methodology": "fee schedule", "standard_charge_dollar": 65.34, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 138.52, "additional_payer_notes": "212.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medical Rental Network", "methodology": "fee schedule", "standard_charge_dollar": 138.52, "additional_payer_notes": "212.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 65.34, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "ALLY-ALIGN (FKA SPARTAN PLAN NJ, INC.)", "plan_name": "ALLY-ALIGN (FKA SPARTAN PLAN NJ, INC.)", "methodology": "fee schedule", "standard_charge_dollar": 68.61, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Americhoice (UHC)", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 65.34, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Amerihealth", "plan_name": "Amerihealth Medicare", "methodology": "fee schedule", "standard_charge_dollar": 65.34, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 94.74, "additional_payer_notes": "A Indicator - 155.00% of Medicare Rates" }, { "payer_name": "Clover Health", "plan_name": "Clover Medicare", "methodology": "fee schedule", "standard_charge_dollar": 65.34, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Coventry", "plan_name": "Coventry Auto", "methodology": "fee schedule", "standard_charge_dollar": 130.68, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Coventry", "plan_name": "Coventry Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 130.68, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "fee schedule", "standard_charge_dollar": 91.48, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Fairprice Healthcare Holdings", "plan_name": "Fairprice Healthcare Holdings", "methodology": "fee schedule", "standard_charge_dollar": 78.41, "additional_payer_notes": "Laboratory - 120.00% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ HMO POS", "methodology": "fee schedule", "standard_charge_dollar": 163.76, "additional_payer_notes": "177.30% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ Indemnity", "methodology": "fee schedule", "standard_charge_dollar": 163.76, "additional_payer_notes": "177.30% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ PPO", "methodology": "fee schedule", "standard_charge_dollar": 163.76, "additional_payer_notes": "177.30% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon Medicare", "methodology": "fee schedule", "standard_charge_dollar": 65.34, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Military Tricare", "methodology": "fee schedule", "standard_charge_dollar": 52.27, "additional_payer_notes": "80.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 65.34, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 65.34, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC All Payer (02-01-2023 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 39.2 }, { "payer_name": "UHC", "plan_name": "UHC Medicaid (02/01/2023 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 52.27 }, { "payer_name": "UHC", "plan_name": "UHC Oxford (02-01-2023 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 39.2 }, { "payer_name": "UHC - Adhoc", "plan_name": "UHC - Adhoc All Payer", "methodology": "fee schedule", "standard_charge_dollar": 65.34 }, { "payer_name": "UHC - Adhoc", "plan_name": "UHC - Adhoc Oxford", "methodology": "fee schedule", "standard_charge_dollar": 65.34 } ] } ] }, { "description": "Hc Aortic Dys/Dilat Genom Seq Ana", "code_information": [ { "code": "81410", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 13750.0, "discounted_cash": 504.0, "minimum": 302.4, "maximum": 11687.5, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 1068.48, "additional_payer_notes": "212.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medical Rental Network", "methodology": "fee schedule", "standard_charge_dollar": 1068.48, "additional_payer_notes": "212.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 504.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "ALLY-ALIGN (FKA SPARTAN PLAN NJ, INC.)", "plan_name": "ALLY-ALIGN (FKA SPARTAN PLAN NJ, INC.)", "methodology": "fee schedule", "standard_charge_dollar": 529.2, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Americhoice (UHC)", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 504.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Amerihealth", "plan_name": "Amerihealth Medicare", "methodology": "fee schedule", "standard_charge_dollar": 504.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 730.8, "additional_payer_notes": "A Indicator - 155.00% of Medicare Rates" }, { "payer_name": "Clover Health", "plan_name": "Clover Medicare", "methodology": "fee schedule", "standard_charge_dollar": 504.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Coventry", "plan_name": "Coventry Auto", "methodology": "fee schedule", "standard_charge_dollar": 1008.0, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Coventry", "plan_name": "Coventry Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 1008.0, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "fee schedule", "standard_charge_dollar": 705.6, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Fairprice Healthcare Holdings", "plan_name": "Fairprice Healthcare Holdings", "methodology": "fee schedule", "standard_charge_dollar": 604.8, "additional_payer_notes": "Laboratory - 120.00% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ HMO POS", "methodology": "fee schedule", "standard_charge_dollar": 9707.5, "additional_payer_notes": "177.30% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ Indemnity", "methodology": "fee schedule", "standard_charge_dollar": 9707.5, "additional_payer_notes": "177.30% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ PPO", "methodology": "fee schedule", "standard_charge_dollar": 9707.5, "additional_payer_notes": "177.30% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon Medicare", "methodology": "fee schedule", "standard_charge_dollar": 504.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Military Tricare", "methodology": "fee schedule", "standard_charge_dollar": 403.2, "additional_payer_notes": "80.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 504.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 504.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC All Payer (02-01-2023 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 302.4 }, { "payer_name": "UHC", "plan_name": "UHC Medicaid (02/01/2023 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 403.2 }, { "payer_name": "UHC", "plan_name": "UHC Oxford (02-01-2023 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 302.4 }, { "payer_name": "UHC - Adhoc", "plan_name": "UHC - Adhoc All Payer", "methodology": "fee schedule", "standard_charge_dollar": 504.0 }, { "payer_name": "UHC - Adhoc", "plan_name": "UHC - Adhoc Oxford", "methodology": "fee schedule", "standard_charge_dollar": 504.0 }, { "payer_name": "Wellcare", "plan_name": "Wellcare Insurance Exchange", "methodology": "fee schedule", "standard_charge_dollar": 680.4, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 504.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup Medicare", "methodology": "fee schedule", "standard_charge_dollar": 504.0, "additional_payer_notes": "100.00% of Medicare Rates" } ] } ] }, { "description": "Hc Ep Eval Cardiovert Leads+Gen, At Implant/Replace", "code_information": [ { "code": "93641", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 5430.0, "minimum": 1036.587, "maximum": 4344.0, "payers_information": [ { "payer_name": "UHC", "plan_name": "UHC All Payer (02-01-2023 to 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 3057.0 }, { "payer_name": "UHC", "plan_name": "UHC Oxford (02-01-2023 to 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 2297.0 }, { "payer_name": "UHC - Adhoc", "plan_name": "UHC - Adhoc All Payer", "methodology": "case rate", "standard_charge_dollar": 3245.0 }, { "payer_name": "UHC - Adhoc", "plan_name": "UHC - Adhoc Oxford", "methodology": "case rate", "standard_charge_dollar": 2367.0 }, { "payer_name": "Wellchoice", "plan_name": "WELLCHOICE HMO of NJ (Empire) Commercial (HMO / HMO POS, PPO)", "methodology": "case rate", "standard_charge_dollar": 2472.0 }, { "payer_name": "Wellchoice", "plan_name": "WELLCHOICE HMO of NJ (Empire) Commercial (Indemnity)", "methodology": "case rate", "standard_charge_dollar": 2753.0 } ] } ] }, { "description": "Hc Brca1&Brca2 Full Seq Analys/Full Dup/Del Analys", "code_information": [ { "code": "81162", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 9124.4, "discounted_cash": 1824.0, "minimum": 1094.93, "maximum": 7755.74, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 3868.75, "additional_payer_notes": "212.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medical Rental Network", "methodology": "fee schedule", "standard_charge_dollar": 3868.75, "additional_payer_notes": "212.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1824.88, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "ALLY-ALIGN (FKA SPARTAN PLAN NJ, INC.)", "plan_name": "ALLY-ALIGN (FKA SPARTAN PLAN NJ, INC.)", "methodology": "fee schedule", "standard_charge_dollar": 1916.12, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Americhoice (UHC)", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1824.88, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Amerihealth", "plan_name": "Amerihealth Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1824.88, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 2646.08, "additional_payer_notes": "A Indicator - 155.00% of Medicare Rates" }, { "payer_name": "Clover Health", "plan_name": "Clover Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1824.88, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Coventry", "plan_name": "Coventry Auto", "methodology": "fee schedule", "standard_charge_dollar": 3649.76, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Coventry", "plan_name": "Coventry Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 3649.76, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "fee schedule", "standard_charge_dollar": 2554.83, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Fairprice Healthcare Holdings", "plan_name": "Fairprice Healthcare Holdings", "methodology": "fee schedule", "standard_charge_dollar": 2189.86, "additional_payer_notes": "Laboratory - 120.00% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ HMO POS", "methodology": "fee schedule", "standard_charge_dollar": 6441.83, "additional_payer_notes": "177.30% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ Indemnity", "methodology": "fee schedule", "standard_charge_dollar": 6441.83, "additional_payer_notes": "177.30% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ PPO", "methodology": "fee schedule", "standard_charge_dollar": 6441.83, "additional_payer_notes": "177.30% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1824.88, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Military Tricare", "methodology": "fee schedule", "standard_charge_dollar": 1459.9, "additional_payer_notes": "80.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1824.88, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 1824.88, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC All Payer (02-01-2023 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 1094.93 }, { "payer_name": "UHC", "plan_name": "UHC Medicaid (02/01/2023 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 1459.9 }, { "payer_name": "UHC", "plan_name": "UHC Oxford (02-01-2023 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 1094.93 }, { "payer_name": "UHC - Adhoc", "plan_name": "UHC - Adhoc All Payer", "methodology": "fee schedule", "standard_charge_dollar": 1824.88 }, { "payer_name": "UHC - Adhoc", "plan_name": "UHC - Adhoc Oxford", "methodology": "fee schedule", "standard_charge_dollar": 1824.88 }, { "payer_name": "Wellcare", "plan_name": "Wellcare Insurance Exchange", "methodology": "fee schedule", "standard_charge_dollar": 2463.59, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1824.88, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1824.88, "additional_payer_notes": "100.00% of Medicare Rates" } ] } ] }, { "description": "INTERSTITIAL & ALVEOLAR LUNG DISEASES - SOI : 3", "code_information": [ { "code": "1423", "type": "APR-DRG" } ], "standard_charges": [ { "setting": "inpatient", "minimum": 13168.72, "maximum": 14485.6, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Better Health - Medi Medi", "methodology": "case rate", "standard_charge_dollar": 14485.6, "additional_payer_notes": "110% of State Medicaid Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Better Health Medicaid", "methodology": "case rate", "standard_charge_dollar": 14485.6, "additional_payer_notes": "110% of State Medicaid Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "case rate", "standard_charge_dollar": 13168.72, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "UBH", "plan_name": "UBH Medicaid", "methodology": "case rate", "standard_charge_dollar": 13168.72, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicaid (02/01/2023 to 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 13432.1, "additional_payer_notes": "102% of State Medicaid Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicaid", "methodology": "case rate", "standard_charge_dollar": 13168.72, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup Medicaid", "methodology": "case rate", "standard_charge_dollar": 13168.72, "additional_payer_notes": "100% of State Medicaid Rates" } ] } ] }, { "description": "Rpr Fem Hernia Init Blocked", "code_information": [ { "code": "49553", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 21637.5, "discounted_cash": 4232.0, "minimum": 1715.0, "maximum": 17310.0, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 8973.47, "additional_payer_notes": "212.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medical Rental Network", "methodology": "fee schedule", "standard_charge_dollar": 8973.47, "additional_payer_notes": "212.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 4232.77, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "ALLY-ALIGN (FKA SPARTAN PLAN NJ, INC.)", "plan_name": "ALLY-ALIGN (FKA SPARTAN PLAN NJ, INC.)", "methodology": "fee schedule", "standard_charge_dollar": 4444.41, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Americhoice (UHC)", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 4232.77, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Amerihealth", "plan_name": "Amerihealth Medicare", "methodology": "fee schedule", "standard_charge_dollar": 4232.77, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 6220.06, "additional_payer_notes": "146.95% of Medicare Rates" }, { "payer_name": "Clover Health", "plan_name": "Clover Medicare", "methodology": "fee schedule", "standard_charge_dollar": 4232.77, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Coventry", "plan_name": "Coventry Auto", "methodology": "fee schedule", "standard_charge_dollar": 8465.54, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Coventry", "plan_name": "Coventry Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 8465.54, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "fee schedule", "standard_charge_dollar": 5925.88, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Fairprice Healthcare Holdings", "plan_name": "Fairprice Healthcare Holdings", "methodology": "fee schedule", "standard_charge_dollar": 6772.43, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ HMO POS", "methodology": "fee schedule", "standard_charge_dollar": 7504.7, "additional_payer_notes": "177.30% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ Indemnity", "methodology": "fee schedule", "standard_charge_dollar": 7504.7, "additional_payer_notes": "177.30% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ PPO", "methodology": "fee schedule", "standard_charge_dollar": 7504.7, "additional_payer_notes": "177.30% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon Medicare", "methodology": "fee schedule", "standard_charge_dollar": 4232.77, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Military Tricare", "methodology": "fee schedule", "standard_charge_dollar": 3386.22, "additional_payer_notes": "80.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 4232.77, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 4232.77, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC All Payer (02-01-2023 to 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 5378.0 }, { "payer_name": "UHC", "plan_name": "UHC Oxford (02-01-2023 to 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 5169.0 }, { "payer_name": "UHC - Adhoc", "plan_name": "UHC - Adhoc All Payer", "methodology": "case rate", "standard_charge_dollar": 5709.0 }, { "payer_name": "UHC - Adhoc", "plan_name": "UHC - Adhoc Oxford", "methodology": "case rate", "standard_charge_dollar": 5327.0 }, { "payer_name": "Wellcare", "plan_name": "Wellcare Insurance Exchange", "methodology": "fee schedule", "standard_charge_dollar": 5714.24, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 4232.77, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellchoice", "plan_name": "WELLCHOICE HMO of NJ (Empire) Commercial (HMO / HMO POS, PPO)", "methodology": "case rate", "standard_charge_dollar": 1715.0 }, { "payer_name": "Wellchoice", "plan_name": "WELLCHOICE HMO of NJ (Empire) Commercial (Indemnity)", "methodology": "case rate", "standard_charge_dollar": 1978.0 }, { "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup Medicare", "methodology": "fee schedule", "standard_charge_dollar": 4232.77, "additional_payer_notes": "100.00% of Medicare Rates" } ] } ] }, { "description": "NEUROLOGICAL EYE DISORDERS", "code_information": [ { "code": "123", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 10785.0, "minimum": 4701.36, "maximum": 19522.1532, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "case rate", "standard_charge_dollar": 19522.15, "additional_payer_notes": "181.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medical Rental Network", "methodology": "case rate", "standard_charge_dollar": 19522.15, "additional_payer_notes": "181.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "case rate", "standard_charge_dollar": 8967.35, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "ALLY-ALIGN (FKA SPARTAN PLAN NJ, INC.)", "plan_name": "ALLY-ALIGN (FKA SPARTAN PLAN NJ, INC.)", "methodology": "case rate", "standard_charge_dollar": 11325.01, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Americhoice (UHC)", "plan_name": "UHC Medicare", "methodology": "case rate", "standard_charge_dollar": 8967.35, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Amerihealth", "plan_name": "Amerihealth Medicare", "methodology": "case rate", "standard_charge_dollar": 8967.35, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Commercial", "methodology": "case rate", "standard_charge_dollar": 11683.52 }, { "payer_name": "Clover Health", "plan_name": "Clover Medicare", "methodology": "case rate", "standard_charge_dollar": 8967.35, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Coventry", "plan_name": "Coventry Auto", "methodology": "case rate", "standard_charge_dollar": 18335.72, "additional_payer_notes": "170.00% of Medicare Rates" }, { "payer_name": "Coventry", "plan_name": "Coventry Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 18335.72, "additional_payer_notes": "170.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "case rate", "standard_charge_dollar": 14021.44, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Fairprice Healthcare Holdings", "plan_name": "Fairprice Healthcare Holdings", "methodology": "case rate", "standard_charge_dollar": 17257.15, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon Medicare", "methodology": "case rate", "standard_charge_dollar": 8967.35, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon NJ Health Medicaid", "methodology": "case rate", "standard_charge_dollar": 4701.36 }, { "payer_name": "Humana", "plan_name": "Humana Military Tricare", "methodology": "case rate", "standard_charge_dollar": 8628.58, "additional_payer_notes": "80.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 10785.72, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 11696.8 }, { "payer_name": "UBH", "plan_name": "UBH Medicare", "methodology": "case rate", "standard_charge_dollar": 8967.35, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC All Payer (02-01-2023 to 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 13461.2 }, { "payer_name": "UHC", "plan_name": "UHC Oxford (02-01-2023 to 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 11731.43 }, { "payer_name": "UHC - Adhoc", "plan_name": "UHC - Adhoc All Payer", "methodology": "case rate", "standard_charge_dollar": 14289.35 }, { "payer_name": "UHC - Adhoc", "plan_name": "UHC - Adhoc Oxford", "methodology": "case rate", "standard_charge_dollar": 12089.21 }, { "payer_name": "Wellcare", "plan_name": "Wellcare Insurance Exchange", "methodology": "case rate", "standard_charge_dollar": 14560.72, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "case rate", "standard_charge_dollar": 8967.35, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup Medicare", "methodology": "case rate", "standard_charge_dollar": 8967.35, "additional_payer_notes": "100.00% of Medicare Rates" } ] } ] }, { "description": "OTHER HEPATOBILIARY OR PANCREAS O.R. PROCEDURES WITHOUT CCMCC", "code_information": [ { "code": "425", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 18894.0, "minimum": 9322.17, "maximum": 34199.7509, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "case rate", "standard_charge_dollar": 34199.75, "additional_payer_notes": "181.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medical Rental Network", "methodology": "case rate", "standard_charge_dollar": 34199.75, "additional_payer_notes": "181.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "case rate", "standard_charge_dollar": 15478.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "ALLY-ALIGN (FKA SPARTAN PLAN NJ, INC.)", "plan_name": "ALLY-ALIGN (FKA SPARTAN PLAN NJ, INC.)", "methodology": "case rate", "standard_charge_dollar": 19839.63, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Americhoice (UHC)", "plan_name": "UHC Medicare", "methodology": "case rate", "standard_charge_dollar": 15478.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Amerihealth", "plan_name": "Amerihealth Medicare", "methodology": "case rate", "standard_charge_dollar": 15478.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Commercial", "methodology": "case rate", "standard_charge_dollar": 21949.39 }, { "payer_name": "Clover Health", "plan_name": "Clover Medicare", "methodology": "case rate", "standard_charge_dollar": 15478.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Coventry", "plan_name": "Coventry Auto", "methodology": "case rate", "standard_charge_dollar": 32121.31, "additional_payer_notes": "170.00% of Medicare Rates" }, { "payer_name": "Coventry", "plan_name": "Coventry Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 32121.31, "additional_payer_notes": "170.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "case rate", "standard_charge_dollar": 24563.36, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Fairprice Healthcare Holdings", "plan_name": "Fairprice Healthcare Holdings", "methodology": "case rate", "standard_charge_dollar": 30231.82, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon Medicare", "methodology": "case rate", "standard_charge_dollar": 15478.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon NJ Health Medicaid", "methodology": "case rate", "standard_charge_dollar": 9322.17 }, { "payer_name": "Humana", "plan_name": "Humana Military Tricare", "methodology": "case rate", "standard_charge_dollar": 15115.91, "additional_payer_notes": "80.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 18894.89, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 22489.2 }, { "payer_name": "UBH", "plan_name": "UBH Medicare", "methodology": "case rate", "standard_charge_dollar": 15478.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC All Payer (02-01-2023 to 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 25289.06 }, { "payer_name": "UHC", "plan_name": "UHC Oxford (02-01-2023 to 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 22039.41 }, { "payer_name": "UHC - Adhoc", "plan_name": "UHC - Adhoc All Payer", "methodology": "case rate", "standard_charge_dollar": 26844.87 }, { "payer_name": "UHC - Adhoc", "plan_name": "UHC - Adhoc Oxford", "methodology": "case rate", "standard_charge_dollar": 22711.54 }, { "payer_name": "Wellcare", "plan_name": "Wellcare Insurance Exchange", "methodology": "case rate", "standard_charge_dollar": 25508.1, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "case rate", "standard_charge_dollar": 15478.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup Medicare", "methodology": "case rate", "standard_charge_dollar": 15478.8, "additional_payer_notes": "100.00% of Medicare Rates" } ] } ] }, { "description": "EXTRACORPOREAL MEMBRANE OXYGENATION (ECMO)- SOI : 3", "code_information": [ { "code": "0093", "type": "APR-DRG" } ], "standard_charges": [ { "setting": "inpatient", "minimum": 89979.46, "maximum": 98977.41, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Better Health - Medi Medi", "methodology": "case rate", "standard_charge_dollar": 98977.41, "additional_payer_notes": "110% of State Medicaid Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Better Health Medicaid", "methodology": "case rate", "standard_charge_dollar": 98977.41, "additional_payer_notes": "110% of State Medicaid Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "case rate", "standard_charge_dollar": 89979.46, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "UBH", "plan_name": "UBH Medicaid", "methodology": "case rate", "standard_charge_dollar": 89979.46, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicaid (02/01/2023 to 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 91779.05, "additional_payer_notes": "102% of State Medicaid Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicaid", "methodology": "case rate", "standard_charge_dollar": 89979.46, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup Medicaid", "methodology": "case rate", "standard_charge_dollar": 89979.46, "additional_payer_notes": "100% of State Medicaid Rates" } ] } ] }, { "description": "NEONATE BWT 2000-2499G W OTHER SIGNIFICANT CONDITION - SOI : 1", "code_information": [ { "code": "6251", "type": "APR-DRG" } ], "standard_charges": [ { "setting": "inpatient", "minimum": 12780.72, "maximum": 14058.79, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Better Health - Medi Medi", "methodology": "case rate", "standard_charge_dollar": 14058.79, "additional_payer_notes": "110% of State Medicaid Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Better Health Medicaid", "methodology": "case rate", "standard_charge_dollar": 14058.79, "additional_payer_notes": "110% of State Medicaid Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "case rate", "standard_charge_dollar": 12780.72, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "UBH", "plan_name": "UBH Medicaid", "methodology": "case rate", "standard_charge_dollar": 12780.72, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicaid (02/01/2023 to 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 13036.33, "additional_payer_notes": "102% of State Medicaid Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicaid", "methodology": "case rate", "standard_charge_dollar": 12780.72, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup Medicaid", "methodology": "case rate", "standard_charge_dollar": 12780.72, "additional_payer_notes": "100% of State Medicaid Rates" } ] } ] }, { "description": "Hc Assay Of Amphetamines - 80324 - 30100323", "code_information": [ { "code": "80324", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 44.0, "minimum": 8.3996, "maximum": 37.4, "payers_information": [ { "payer_name": "UHC", "plan_name": "UHC Medicaid (02/01/2023 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 17.62 } ] } ] }, { "description": "NON-EXTENSIVE O.R. PROCEDURE UNRELATED TO PRINCIPAL DIAGNOSIS- SOI : 4", "code_information": [ { "code": "9524", "type": "APR-DRG" } ], "standard_charges": [ { "setting": "inpatient", "minimum": 46514.66, "maximum": 51166.12, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Better Health - Medi Medi", "methodology": "case rate", "standard_charge_dollar": 51166.12, "additional_payer_notes": "110% of State Medicaid Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Better Health Medicaid", "methodology": "case rate", "standard_charge_dollar": 51166.12, "additional_payer_notes": "110% of State Medicaid Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "case rate", "standard_charge_dollar": 46514.66, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "UBH", "plan_name": "UBH Medicaid", "methodology": "case rate", "standard_charge_dollar": 46514.66, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicaid (02/01/2023 to 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 47444.95, "additional_payer_notes": "102% of State Medicaid Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicaid", "methodology": "case rate", "standard_charge_dollar": 46514.66, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup Medicaid", "methodology": "case rate", "standard_charge_dollar": 46514.66, "additional_payer_notes": "100% of State Medicaid Rates" } ] } ] }, { "description": "OTHER ENDOCRINE DISORDERS - SOI : 4", "code_information": [ { "code": "4244", "type": "APR-DRG" } ], "standard_charges": [ { "setting": "inpatient", "minimum": 22897.05, "maximum": 25186.76, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Better Health - Medi Medi", "methodology": "case rate", "standard_charge_dollar": 25186.76, "additional_payer_notes": "110% of State Medicaid Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Better Health Medicaid", "methodology": "case rate", "standard_charge_dollar": 25186.76, "additional_payer_notes": "110% of State Medicaid Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "case rate", "standard_charge_dollar": 22897.05, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "UBH", "plan_name": "UBH Medicaid", "methodology": "case rate", "standard_charge_dollar": 22897.05, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicaid (02/01/2023 to 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 23354.99, "additional_payer_notes": "102% of State Medicaid Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicaid", "methodology": "case rate", "standard_charge_dollar": 22897.05, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup Medicaid", "methodology": "case rate", "standard_charge_dollar": 22897.05, "additional_payer_notes": "100% of State Medicaid Rates" } ] } ] }, { "description": "Hc Chemother Prolong Infuse W/Pump", "code_information": [ { "code": "96416", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 1397.25, "discounted_cash": 390.0, "minimum": 167.0, "maximum": 1397.25, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 827.84, "additional_payer_notes": "212.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medical Rental Network", "methodology": "fee schedule", "standard_charge_dollar": 827.84, "additional_payer_notes": "212.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 390.49, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "ALLY-ALIGN (FKA SPARTAN PLAN NJ, INC.)", "plan_name": "ALLY-ALIGN (FKA SPARTAN PLAN NJ, INC.)", "methodology": "fee schedule", "standard_charge_dollar": 410.01, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Americhoice (UHC)", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 390.49, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Amerihealth", "plan_name": "Amerihealth Medicare", "methodology": "fee schedule", "standard_charge_dollar": 390.49, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 573.83, "additional_payer_notes": "146.95% of Medicare Rates" }, { "payer_name": "Clover Health", "plan_name": "Clover Medicare", "methodology": "fee schedule", "standard_charge_dollar": 390.49, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Coventry", "plan_name": "Coventry Auto", "methodology": "fee schedule", "standard_charge_dollar": 780.98, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Coventry", "plan_name": "Coventry Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 780.98, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "fee schedule", "standard_charge_dollar": 546.69, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Fairprice Healthcare Holdings", "plan_name": "Fairprice Healthcare Holdings", "methodology": "fee schedule", "standard_charge_dollar": 624.78, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ HMO POS", "methodology": "fee schedule", "standard_charge_dollar": 692.34, "additional_payer_notes": "177.30% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ Indemnity", "methodology": "fee schedule", "standard_charge_dollar": 692.34, "additional_payer_notes": "177.30% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ PPO", "methodology": "fee schedule", "standard_charge_dollar": 692.34, "additional_payer_notes": "177.30% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon Medicare", "methodology": "fee schedule", "standard_charge_dollar": 390.49, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Military Tricare", "methodology": "fee schedule", "standard_charge_dollar": 312.39, "additional_payer_notes": "80.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 390.49, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 390.49, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC All Payer (02-01-2023 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 1397.25 }, { "payer_name": "UHC", "plan_name": "UHC Oxford (02-01-2023 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 1397.25 }, { "payer_name": "UHC - Adhoc", "plan_name": "UHC - Adhoc All Payer", "methodology": "fee schedule", "standard_charge_dollar": 1397.25 }, { "payer_name": "UHC - Adhoc", "plan_name": "UHC - Adhoc Oxford", "methodology": "fee schedule", "standard_charge_dollar": 1397.25 }, { "payer_name": "Wellcare", "plan_name": "Wellcare Insurance Exchange", "methodology": "fee schedule", "standard_charge_dollar": 527.16, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 390.49, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellchoice", "plan_name": "WELLCHOICE HMO of NJ (Empire) Commercial (HMO / HMO POS, PPO)", "methodology": "case rate", "standard_charge_dollar": 167.0 }, { "payer_name": "Wellchoice", "plan_name": "WELLCHOICE HMO of NJ (Empire) Commercial (Indemnity)", "methodology": "case rate", "standard_charge_dollar": 202.0 }, { "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup Medicare", "methodology": "fee schedule", "standard_charge_dollar": 390.49, "additional_payer_notes": "100.00% of Medicare Rates" } ] } ] }, { "description": "Hc Assay Blood Carbon Dioxide", "code_information": [ { "code": "82374", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 54.0, "discounted_cash": 4.0, "minimum": 2.93, "maximum": 45.9, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 10.35, "additional_payer_notes": "212.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medical Rental Network", "methodology": "fee schedule", "standard_charge_dollar": 10.35, "additional_payer_notes": "212.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 4.88, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "ALLY-ALIGN (FKA SPARTAN PLAN NJ, INC.)", "plan_name": "ALLY-ALIGN (FKA SPARTAN PLAN NJ, INC.)", "methodology": "fee schedule", "standard_charge_dollar": 5.12, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Americhoice (UHC)", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 4.88, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Amerihealth", "plan_name": "Amerihealth Medicare", "methodology": "fee schedule", "standard_charge_dollar": 4.88, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 7.08, "additional_payer_notes": "Laboratory - 145.00% of Medicare Rates" }, { "payer_name": "Clover Health", "plan_name": "Clover Medicare", "methodology": "fee schedule", "standard_charge_dollar": 4.88, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Coventry", "plan_name": "Coventry Auto", "methodology": "fee schedule", "standard_charge_dollar": 9.76, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Coventry", "plan_name": "Coventry Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 9.76, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "fee schedule", "standard_charge_dollar": 6.83, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Fairprice Healthcare Holdings", "plan_name": "Fairprice Healthcare Holdings", "methodology": "fee schedule", "standard_charge_dollar": 5.86, "additional_payer_notes": "Laboratory - 120.00% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ HMO POS", "methodology": "fee schedule", "standard_charge_dollar": 38.12, "additional_payer_notes": "177.30% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ Indemnity", "methodology": "fee schedule", "standard_charge_dollar": 38.12, "additional_payer_notes": "177.30% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ PPO", "methodology": "fee schedule", "standard_charge_dollar": 38.12, "additional_payer_notes": "177.30% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon Medicare", "methodology": "fee schedule", "standard_charge_dollar": 4.88, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Military Tricare", "methodology": "fee schedule", "standard_charge_dollar": 3.9, "additional_payer_notes": "80.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 4.88, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 4.88, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC All Payer (02-01-2023 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 2.93 }, { "payer_name": "UHC", "plan_name": "UHC Medicaid (02/01/2023 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 3.9 }, { "payer_name": "UHC", "plan_name": "UHC Oxford (02-01-2023 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 2.93 }, { "payer_name": "UHC - Adhoc", "plan_name": "UHC - Adhoc All Payer", "methodology": "fee schedule", "standard_charge_dollar": 4.88 }, { "payer_name": "UHC - Adhoc", "plan_name": "UHC - Adhoc Oxford", "methodology": "fee schedule", "standard_charge_dollar": 4.88 }, { "payer_name": "Wellcare", "plan_name": "Wellcare Insurance Exchange", "methodology": "fee schedule", "standard_charge_dollar": 6.59, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 4.88, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup Medicare", "methodology": "fee schedule", "standard_charge_dollar": 4.88, "additional_payer_notes": "100.00% of Medicare Rates" } ] } ] }, { "description": "GASTROINTESTINAL OBSTRUCTION WITH CC", "code_information": [ { "code": "389", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 10684.0, "minimum": 5265.22, "maximum": 19338.0762, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "case rate", "standard_charge_dollar": 19338.08, "additional_payer_notes": "181.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medical Rental Network", "methodology": "case rate", "standard_charge_dollar": 19338.08, "additional_payer_notes": "181.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "case rate", "standard_charge_dollar": 8885.69, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "ALLY-ALIGN (FKA SPARTAN PLAN NJ, INC.)", "plan_name": "ALLY-ALIGN (FKA SPARTAN PLAN NJ, INC.)", "methodology": "case rate", "standard_charge_dollar": 11218.22, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Americhoice (UHC)", "plan_name": "UHC Medicare", "methodology": "case rate", "standard_charge_dollar": 8885.69, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Amerihealth", "plan_name": "Amerihealth Medicare", "methodology": "case rate", "standard_charge_dollar": 8885.69, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Commercial", "methodology": "case rate", "standard_charge_dollar": 11554.77 }, { "payer_name": "Clover Health", "plan_name": "Clover Medicare", "methodology": "case rate", "standard_charge_dollar": 8885.69, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Coventry", "plan_name": "Coventry Auto", "methodology": "case rate", "standard_charge_dollar": 18162.83, "additional_payer_notes": "170.00% of Medicare Rates" }, { "payer_name": "Coventry", "plan_name": "Coventry Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 18162.83, "additional_payer_notes": "170.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "case rate", "standard_charge_dollar": 13889.23, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Fairprice Healthcare Holdings", "plan_name": "Fairprice Healthcare Holdings", "methodology": "case rate", "standard_charge_dollar": 17094.43, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon Medicare", "methodology": "case rate", "standard_charge_dollar": 8885.69, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon NJ Health Medicaid", "methodology": "case rate", "standard_charge_dollar": 5265.22 }, { "payer_name": "Humana", "plan_name": "Humana Military Tricare", "methodology": "case rate", "standard_charge_dollar": 8547.22, "additional_payer_notes": "80.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 10684.02, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 7569.35 }, { "payer_name": "UBH", "plan_name": "UBH Medicare", "methodology": "case rate", "standard_charge_dollar": 8885.69, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC All Payer (02-01-2023 to 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 13312.87 }, { "payer_name": "UHC", "plan_name": "UHC Oxford (02-01-2023 to 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 11602.16 }, { "payer_name": "UHC - Adhoc", "plan_name": "UHC - Adhoc All Payer", "methodology": "case rate", "standard_charge_dollar": 14131.89 }, { "payer_name": "UHC - Adhoc", "plan_name": "UHC - Adhoc Oxford", "methodology": "case rate", "standard_charge_dollar": 11955.99 }, { "payer_name": "Wellcare", "plan_name": "Wellcare Insurance Exchange", "methodology": "case rate", "standard_charge_dollar": 14423.43, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "case rate", "standard_charge_dollar": 8885.69, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup Medicare", "methodology": "case rate", "standard_charge_dollar": 8885.69, "additional_payer_notes": "100.00% of Medicare Rates" } ] } ] }, { "description": "ANOXIC & OTHER SEVERE BRAIN DAMAGE - SOI : 4", "code_information": [ { "code": "0594", "type": "APR-DRG" } ], "standard_charges": [ { "setting": "inpatient", "minimum": 21927.67, "maximum": 24120.44, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Better Health - Medi Medi", "methodology": "case rate", "standard_charge_dollar": 24120.44, "additional_payer_notes": "110% of State Medicaid Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Better Health Medicaid", "methodology": "case rate", "standard_charge_dollar": 24120.44, "additional_payer_notes": "110% of State Medicaid Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "case rate", "standard_charge_dollar": 21927.67, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "UBH", "plan_name": "UBH Medicaid", "methodology": "case rate", "standard_charge_dollar": 21927.67, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicaid (02/01/2023 to 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 22366.23, "additional_payer_notes": "102% of State Medicaid Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicaid", "methodology": "case rate", "standard_charge_dollar": 21927.67, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup Medicaid", "methodology": "case rate", "standard_charge_dollar": 21927.67, "additional_payer_notes": "100% of State Medicaid Rates" } ] } ] }, { "description": "MAJOR ESOPHAGEAL DISORDERS WITHOUT CCMCC", "code_information": [ { "code": "370", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 9655.0, "minimum": 4641.41, "maximum": 17476.4369, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "case rate", "standard_charge_dollar": 17476.44, "additional_payer_notes": "181.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medical Rental Network", "methodology": "case rate", "standard_charge_dollar": 17476.44, "additional_payer_notes": "181.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "case rate", "standard_charge_dollar": 8059.81, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "ALLY-ALIGN (FKA SPARTAN PLAN NJ, INC.)", "plan_name": "ALLY-ALIGN (FKA SPARTAN PLAN NJ, INC.)", "methodology": "case rate", "standard_charge_dollar": 10138.26, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Americhoice (UHC)", "plan_name": "UHC Medicare", "methodology": "case rate", "standard_charge_dollar": 8059.81, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Amerihealth", "plan_name": "Amerihealth Medicare", "methodology": "case rate", "standard_charge_dollar": 8059.81, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Commercial", "methodology": "case rate", "standard_charge_dollar": 10252.7 }, { "payer_name": "Clover Health", "plan_name": "Clover Medicare", "methodology": "case rate", "standard_charge_dollar": 8059.81, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Coventry", "plan_name": "Coventry Auto", "methodology": "case rate", "standard_charge_dollar": 16414.33, "additional_payer_notes": "170.00% of Medicare Rates" }, { "payer_name": "Coventry", "plan_name": "Coventry Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 16414.33, "additional_payer_notes": "170.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "case rate", "standard_charge_dollar": 12552.14, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Fairprice Healthcare Holdings", "plan_name": "Fairprice Healthcare Holdings", "methodology": "case rate", "standard_charge_dollar": 15448.78, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon Medicare", "methodology": "case rate", "standard_charge_dollar": 8059.81, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon NJ Health Medicaid", "methodology": "case rate", "standard_charge_dollar": 4641.41 }, { "payer_name": "Humana", "plan_name": "Humana Military Tricare", "methodology": "case rate", "standard_charge_dollar": 7724.39, "additional_payer_notes": "80.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 9655.49, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 8912.83 }, { "payer_name": "UBH", "plan_name": "UBH Medicare", "methodology": "case rate", "standard_charge_dollar": 8059.81, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC All Payer (02-01-2023 to 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 11812.68 }, { "payer_name": "UHC", "plan_name": "UHC Oxford (02-01-2023 to 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 10294.75 }, { "payer_name": "UHC - Adhoc", "plan_name": "UHC - Adhoc All Payer", "methodology": "case rate", "standard_charge_dollar": 12539.41 }, { "payer_name": "UHC - Adhoc", "plan_name": "UHC - Adhoc Oxford", "methodology": "case rate", "standard_charge_dollar": 10608.71 }, { "payer_name": "Wellcare", "plan_name": "Wellcare Insurance Exchange", "methodology": "case rate", "standard_charge_dollar": 13034.91, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "case rate", "standard_charge_dollar": 8059.81, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup Medicare", "methodology": "case rate", "standard_charge_dollar": 8059.81, "additional_payer_notes": "100.00% of Medicare Rates" } ] } ] }, { "description": "OTHER STOMACH, ESOPHAGEAL & DUODENAL PROCEDURES - SOI : 3", "code_information": [ { "code": "2223", "type": "APR-DRG" } ], "standard_charges": [ { "setting": "inpatient", "minimum": 23747.83, "maximum": 26122.62, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Better Health - Medi Medi", "methodology": "case rate", "standard_charge_dollar": 26122.62, "additional_payer_notes": "110% of State Medicaid Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Better Health Medicaid", "methodology": "case rate", "standard_charge_dollar": 26122.62, "additional_payer_notes": "110% of State Medicaid Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "case rate", "standard_charge_dollar": 23747.83, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "UBH", "plan_name": "UBH Medicaid", "methodology": "case rate", "standard_charge_dollar": 23747.83, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicaid (02/01/2023 to 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 24222.79, "additional_payer_notes": "102% of State Medicaid Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicaid", "methodology": "case rate", "standard_charge_dollar": 23747.83, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup Medicaid", "methodology": "case rate", "standard_charge_dollar": 23747.83, "additional_payer_notes": "100% of State Medicaid Rates" } ] } ] }, { "description": "MNL PREP&INSJ IMED RX DEV", "code_information": [ { "code": "20702", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 9818.77, "minimum": 1715.0, "maximum": 7855.016, "payers_information": [ { "payer_name": "UHC", "plan_name": "UHC All Payer (02-01-2023 to 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 3057.0 }, { "payer_name": "UHC", "plan_name": "UHC Oxford (02-01-2023 to 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 2297.0 }, { "payer_name": "UHC - Adhoc", "plan_name": "UHC - Adhoc All Payer", "methodology": "case rate", "standard_charge_dollar": 3245.0 }, { "payer_name": "UHC - Adhoc", "plan_name": "UHC - Adhoc Oxford", "methodology": "case rate", "standard_charge_dollar": 2367.0 }, { "payer_name": "Wellchoice", "plan_name": "WELLCHOICE HMO of NJ (Empire) Commercial (HMO / HMO POS, PPO)", "methodology": "case rate", "standard_charge_dollar": 1715.0 }, { "payer_name": "Wellchoice", "plan_name": "WELLCHOICE HMO of NJ (Empire) Commercial (Indemnity)", "methodology": "case rate", "standard_charge_dollar": 1978.0 } ] } ] }, { "description": "Hc Mra Lower Extrem Wo/W Contrast - 73725 - 61600003", "code_information": [ { "code": "73725", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 3822.95, "minimum": 296.94, "maximum": 3249.5075, "payers_information": [ { "payer_name": "Amerihealth", "plan_name": "Amerihealth HMO", "methodology": "fee schedule", "standard_charge_dollar": 886.6 }, { "payer_name": "UHC", "plan_name": "UHC All Payer (02-01-2023 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 445.41 }, { "payer_name": "UHC", "plan_name": "UHC Oxford (02-01-2023 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 445.41 }, { "payer_name": "UHC - Adhoc", "plan_name": "UHC - Adhoc All Payer", "methodology": "fee schedule", "standard_charge_dollar": 296.94 }, { "payer_name": "UHC - Adhoc", "plan_name": "UHC - Adhoc Oxford", "methodology": "fee schedule", "standard_charge_dollar": 296.94 } ] } ] }, { "description": "GASTROINTESTINAL HEMORRHAGE WITH CC", "code_information": [ { "code": "378", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 12890.0, "minimum": 6183.76, "maximum": 23331.1715, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "case rate", "standard_charge_dollar": 23331.17, "additional_payer_notes": "181.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medical Rental Network", "methodology": "case rate", "standard_charge_dollar": 23331.17, "additional_payer_notes": "181.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "case rate", "standard_charge_dollar": 10657.2, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "ALLY-ALIGN (FKA SPARTAN PLAN NJ, INC.)", "plan_name": "ALLY-ALIGN (FKA SPARTAN PLAN NJ, INC.)", "methodology": "case rate", "standard_charge_dollar": 13534.66, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Americhoice (UHC)", "plan_name": "UHC Medicare", "methodology": "case rate", "standard_charge_dollar": 10657.2, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Amerihealth", "plan_name": "Amerihealth Medicare", "methodology": "case rate", "standard_charge_dollar": 10657.2, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Commercial", "methodology": "case rate", "standard_charge_dollar": 14347.64 }, { "payer_name": "Clover Health", "plan_name": "Clover Medicare", "methodology": "case rate", "standard_charge_dollar": 10657.2, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Coventry", "plan_name": "Coventry Auto", "methodology": "case rate", "standard_charge_dollar": 21913.26, "additional_payer_notes": "170.00% of Medicare Rates" }, { "payer_name": "Coventry", "plan_name": "Coventry Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 21913.26, "additional_payer_notes": "170.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "case rate", "standard_charge_dollar": 16757.2, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Fairprice Healthcare Holdings", "plan_name": "Fairprice Healthcare Holdings", "methodology": "case rate", "standard_charge_dollar": 20624.24, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon Medicare", "methodology": "case rate", "standard_charge_dollar": 10657.2, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon NJ Health Medicaid", "methodology": "case rate", "standard_charge_dollar": 6183.76 }, { "payer_name": "Humana", "plan_name": "Humana Military Tricare", "methodology": "case rate", "standard_charge_dollar": 10312.12, "additional_payer_notes": "80.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 12890.15, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 11463.5 }, { "payer_name": "UBH", "plan_name": "UBH Medicare", "methodology": "case rate", "standard_charge_dollar": 10657.2, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC All Payer (02-01-2023 to 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 16530.68 }, { "payer_name": "UHC", "plan_name": "UHC Oxford (02-01-2023 to 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 14406.48 }, { "payer_name": "UHC - Adhoc", "plan_name": "UHC - Adhoc All Payer", "methodology": "case rate", "standard_charge_dollar": 17547.67 }, { "payer_name": "UHC - Adhoc", "plan_name": "UHC - Adhoc Oxford", "methodology": "case rate", "standard_charge_dollar": 14845.84 }, { "payer_name": "Wellcare", "plan_name": "Wellcare Insurance Exchange", "methodology": "case rate", "standard_charge_dollar": 17401.7, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "case rate", "standard_charge_dollar": 10657.2, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup Medicare", "methodology": "case rate", "standard_charge_dollar": 10657.2, "additional_payer_notes": "100.00% of Medicare Rates" } ] } ] }, { "description": "Hc Escharotomy", "code_information": [ { "code": "16035", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 1636.94, "discounted_cash": 480.0, "minimum": 312.4918, "maximum": 1636.94, "payers_information": [ { "payer_name": "Coventry", "plan_name": "Coventry Auto", "methodology": "fee schedule", "standard_charge_dollar": 961.16, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Coventry", "plan_name": "Coventry Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 961.16, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "fee schedule", "standard_charge_dollar": 672.81, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Fairprice Healthcare Holdings", "plan_name": "Fairprice Healthcare Holdings", "methodology": "fee schedule", "standard_charge_dollar": 768.93, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ HMO POS", "methodology": "fee schedule", "standard_charge_dollar": 852.07, "additional_payer_notes": "177.30% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ Indemnity", "methodology": "fee schedule", "standard_charge_dollar": 852.07, "additional_payer_notes": "177.30% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ PPO", "methodology": "fee schedule", "standard_charge_dollar": 852.07, "additional_payer_notes": "177.30% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon Medicare", "methodology": "fee schedule", "standard_charge_dollar": 480.58, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Military Tricare", "methodology": "fee schedule", "standard_charge_dollar": 384.46, "additional_payer_notes": "80.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 480.58, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 480.58, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC All Payer (02-01-2023 to 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 1636.94 }, { "payer_name": "UHC", "plan_name": "UHC Oxford (02-01-2023 to 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 1636.94 }, { "payer_name": "UHC - Adhoc", "plan_name": "UHC - Adhoc All Payer", "methodology": "case rate", "standard_charge_dollar": 1636.94 }, { "payer_name": "UHC - Adhoc", "plan_name": "UHC - Adhoc Oxford", "methodology": "case rate", "standard_charge_dollar": 1636.94 }, { "payer_name": "Wellcare", "plan_name": "Wellcare Insurance Exchange", "methodology": "fee schedule", "standard_charge_dollar": 648.78, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 480.58, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellchoice", "plan_name": "WELLCHOICE HMO of NJ (Empire) Commercial (HMO / HMO POS, PPO)", "methodology": "case rate", "standard_charge_dollar": 1636.94 }, { "payer_name": "Wellchoice", "plan_name": "WELLCHOICE HMO of NJ (Empire) Commercial (Indemnity)", "methodology": "case rate", "standard_charge_dollar": 1636.94 }, { "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup Medicare", "methodology": "fee schedule", "standard_charge_dollar": 480.58, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 1018.83, "additional_payer_notes": "212.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medical Rental Network", "methodology": "fee schedule", "standard_charge_dollar": 1018.83, "additional_payer_notes": "212.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 480.58, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "ALLY-ALIGN (FKA SPARTAN PLAN NJ, INC.)", "plan_name": "ALLY-ALIGN (FKA SPARTAN PLAN NJ, INC.)", "methodology": "fee schedule", "standard_charge_dollar": 504.61, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Americhoice (UHC)", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 480.58, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Amerihealth", "plan_name": "Amerihealth Medicare", "methodology": "fee schedule", "standard_charge_dollar": 480.58, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 706.21, "additional_payer_notes": "146.95% of Medicare Rates" }, { "payer_name": "Clover Health", "plan_name": "Clover Medicare", "methodology": "fee schedule", "standard_charge_dollar": 480.58, "additional_payer_notes": "100.00% of Medicare Rates" } ] } ] }, { "description": "Hc Assay Urea Nitrogen, Quan", "code_information": [ { "code": "84520", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 85.0, "discounted_cash": 3.0, "minimum": 2.37, "maximum": 72.25, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 8.37, "additional_payer_notes": "212.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medical Rental Network", "methodology": "fee schedule", "standard_charge_dollar": 8.37, "additional_payer_notes": "212.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3.95, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "ALLY-ALIGN (FKA SPARTAN PLAN NJ, INC.)", "plan_name": "ALLY-ALIGN (FKA SPARTAN PLAN NJ, INC.)", "methodology": "fee schedule", "standard_charge_dollar": 4.15, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Americhoice (UHC)", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3.95, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Amerihealth", "plan_name": "Amerihealth Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3.95, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 5.73, "additional_payer_notes": "Laboratory - 145.00% of Medicare Rates" }, { "payer_name": "Clover Health", "plan_name": "Clover Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3.95, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Coventry", "plan_name": "Coventry Auto", "methodology": "fee schedule", "standard_charge_dollar": 7.9, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Coventry", "plan_name": "Coventry Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 7.9, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "fee schedule", "standard_charge_dollar": 5.53, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Fairprice Healthcare Holdings", "plan_name": "Fairprice Healthcare Holdings", "methodology": "fee schedule", "standard_charge_dollar": 4.74, "additional_payer_notes": "Laboratory - 120.00% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ HMO POS", "methodology": "fee schedule", "standard_charge_dollar": 60.01, "additional_payer_notes": "177.30% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ Indemnity", "methodology": "fee schedule", "standard_charge_dollar": 60.01, "additional_payer_notes": "177.30% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ PPO", "methodology": "fee schedule", "standard_charge_dollar": 60.01, "additional_payer_notes": "177.30% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3.95, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Military Tricare", "methodology": "fee schedule", "standard_charge_dollar": 3.16, "additional_payer_notes": "80.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3.95, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 3.95, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC All Payer (02-01-2023 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 2.37 }, { "payer_name": "UHC", "plan_name": "UHC Medicaid (02/01/2023 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 3.16 }, { "payer_name": "UHC", "plan_name": "UHC Oxford (02-01-2023 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 2.37 }, { "payer_name": "UHC - Adhoc", "plan_name": "UHC - Adhoc All Payer", "methodology": "fee schedule", "standard_charge_dollar": 3.95 }, { "payer_name": "UHC - Adhoc", "plan_name": "UHC - Adhoc Oxford", "methodology": "fee schedule", "standard_charge_dollar": 3.95 }, { "payer_name": "Wellcare", "plan_name": "Wellcare Insurance Exchange", "methodology": "fee schedule", "standard_charge_dollar": 5.33, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3.95, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup Medicaid", "methodology": "percent of total billed charges", "standard_charge_percentage": 19.09, "median_amount": 15.85, "10th_percentile": 15.85, "90th_percentile": 15.85, "count": "1 through 10" }, { "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3.95, "additional_payer_notes": "100.00% of Medicare Rates" } ] } ] }, { "description": "NON-MALIGNANT BREAST DISORDERS WITH CCMCC", "code_information": [ { "code": "600", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 13593.0, "minimum": 5944.07, "maximum": 24605.0314, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "case rate", "standard_charge_dollar": 24605.03, "additional_payer_notes": "181.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medical Rental Network", "methodology": "case rate", "standard_charge_dollar": 24605.03, "additional_payer_notes": "181.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "case rate", "standard_charge_dollar": 11222.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "ALLY-ALIGN (FKA SPARTAN PLAN NJ, INC.)", "plan_name": "ALLY-ALIGN (FKA SPARTAN PLAN NJ, INC.)", "methodology": "case rate", "standard_charge_dollar": 14273.64, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Americhoice (UHC)", "plan_name": "UHC Medicare", "methodology": "case rate", "standard_charge_dollar": 11222.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Amerihealth", "plan_name": "Amerihealth Medicare", "methodology": "case rate", "standard_charge_dollar": 11222.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Commercial", "methodology": "case rate", "standard_charge_dollar": 15238.61 }, { "payer_name": "Clover Health", "plan_name": "Clover Medicare", "methodology": "case rate", "standard_charge_dollar": 11222.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Coventry", "plan_name": "Coventry Auto", "methodology": "case rate", "standard_charge_dollar": 23109.7, "additional_payer_notes": "170.00% of Medicare Rates" }, { "payer_name": "Coventry", "plan_name": "Coventry Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 23109.7, "additional_payer_notes": "170.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "case rate", "standard_charge_dollar": 17672.12, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Fairprice Healthcare Holdings", "plan_name": "Fairprice Healthcare Holdings", "methodology": "case rate", "standard_charge_dollar": 21750.3, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon Medicare", "methodology": "case rate", "standard_charge_dollar": 11222.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon NJ Health Medicaid", "methodology": "case rate", "standard_charge_dollar": 5969.58 }, { "payer_name": "Humana", "plan_name": "Humana Military Tricare", "methodology": "case rate", "standard_charge_dollar": 10875.15, "additional_payer_notes": "80.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 13593.94, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 5944.07 }, { "payer_name": "UBH", "plan_name": "UBH Medicare", "methodology": "case rate", "standard_charge_dollar": 11222.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC All Payer (02-01-2023 to 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 17557.21 }, { "payer_name": "UHC", "plan_name": "UHC Oxford (02-01-2023 to 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 15301.1 }, { "payer_name": "UHC - Adhoc", "plan_name": "UHC - Adhoc All Payer", "methodology": "case rate", "standard_charge_dollar": 18637.35 }, { "payer_name": "UHC - Adhoc", "plan_name": "UHC - Adhoc Oxford", "methodology": "case rate", "standard_charge_dollar": 15767.74 }, { "payer_name": "Wellcare", "plan_name": "Wellcare Insurance Exchange", "methodology": "case rate", "standard_charge_dollar": 18351.82, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "case rate", "standard_charge_dollar": 11222.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup Medicare", "methodology": "case rate", "standard_charge_dollar": 11222.3, "additional_payer_notes": "100.00% of Medicare Rates" } ] } ] }, { "description": "Hc Moder Sedate Same Phys/Qhp 5/>Yrs Init 15 Min", "code_information": [ { "code": "99152", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 851.13, "minimum": 162.4807, "maximum": 723.4605, "payers_information": [ { "payer_name": "Horizon", "plan_name": "Horizon NJ Health Medicaid", "methodology": "percent of total billed charges", "standard_charge_percentage": 19.58, "median_amount": 166.65, "10th_percentile": 166.65, "90th_percentile": 166.65, "count": "49" }, { "payer_name": "UHC", "plan_name": "UHC Medicaid (02/01/2023 to 12-31-2026)", "methodology": "percent of total billed charges", "standard_charge_percentage": 19.47, "median_amount": 161.91, "10th_percentile": 161.91, "90th_percentile": 161.91, "count": "16" }, { "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup Medicaid", "methodology": "percent of total billed charges", "standard_charge_percentage": 19.09, "median_amount": 158.74, "10th_percentile": 158.74, "90th_percentile": 158.74, "count": "14" } ] } ] }, { "description": "Hc Office Outpatient New 10 Min", "code_information": [ { "code": "G0463", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 251.0, "discounted_cash": 157.0, "minimum": 19.09, "maximum": 1131.35, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 251.0, "additional_payer_notes": "212.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medical Rental Network", "methodology": "fee schedule", "standard_charge_dollar": 251.0, "additional_payer_notes": "212.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 157.39, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "ALLY-ALIGN (FKA SPARTAN PLAN NJ, INC.)", "plan_name": "ALLY-ALIGN (FKA SPARTAN PLAN NJ, INC.)", "methodology": "fee schedule", "standard_charge_dollar": 165.26, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Americhoice (UHC)", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 157.39, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Amerihealth", "plan_name": "Amerihealth Medicare", "methodology": "fee schedule", "standard_charge_dollar": 157.39, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 231.28, "additional_payer_notes": "146.95% of Medicare Rates" }, { "payer_name": "Clover Health", "plan_name": "Clover Medicare", "methodology": "fee schedule", "standard_charge_dollar": 157.39, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Coventry", "plan_name": "Coventry Auto", "methodology": "fee schedule", "standard_charge_dollar": 251.0, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Coventry", "plan_name": "Coventry Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 251.0, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "fee schedule", "standard_charge_dollar": 220.35, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Fairprice Healthcare Holdings", "plan_name": "Fairprice Healthcare Holdings", "methodology": "fee schedule", "standard_charge_dollar": 251.0, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ HMO POS", "methodology": "fee schedule", "standard_charge_dollar": 251.0, "additional_payer_notes": "177.30% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ Indemnity", "methodology": "fee schedule", "standard_charge_dollar": 251.0, "additional_payer_notes": "177.30% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ PPO", "methodology": "fee schedule", "standard_charge_dollar": 251.0, "additional_payer_notes": "177.30% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon Medicare", "methodology": "fee schedule", "standard_charge_dollar": 157.39, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Military Tricare", "methodology": "fee schedule", "standard_charge_dollar": 125.91, "additional_payer_notes": "80.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 157.39, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 157.39, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Insurance Exchange", "methodology": "fee schedule", "standard_charge_dollar": 212.48, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 157.39, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup Medicare", "methodology": "fee schedule", "standard_charge_dollar": 157.39, "additional_payer_notes": "100.00% of Medicare Rates" } ] } ] }, { "description": "UNLISTED PX TRACHEA BRONCHI", "code_information": [ { "code": "31899", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 5770.0, "discounted_cash": 235.0, "minimum": 188.776, "maximum": 4616.0, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 500.26, "additional_payer_notes": "212.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medical Rental Network", "methodology": "fee schedule", "standard_charge_dollar": 500.26, "additional_payer_notes": "212.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 235.97, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "ALLY-ALIGN (FKA SPARTAN PLAN NJ, INC.)", "plan_name": "ALLY-ALIGN (FKA SPARTAN PLAN NJ, INC.)", "methodology": "fee schedule", "standard_charge_dollar": 247.77, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Americhoice (UHC)", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 235.97, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Amerihealth", "plan_name": "Amerihealth Medicare", "methodology": "fee schedule", "standard_charge_dollar": 235.97, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 346.76, "additional_payer_notes": "146.95% of Medicare Rates" }, { "payer_name": "Clover Health", "plan_name": "Clover Medicare", "methodology": "fee schedule", "standard_charge_dollar": 235.97, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Coventry", "plan_name": "Coventry Auto", "methodology": "fee schedule", "standard_charge_dollar": 471.94, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Coventry", "plan_name": "Coventry Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 471.94, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "fee schedule", "standard_charge_dollar": 330.36, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Fairprice Healthcare Holdings", "plan_name": "Fairprice Healthcare Holdings", "methodology": "fee schedule", "standard_charge_dollar": 377.55, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ HMO POS", "methodology": "fee schedule", "standard_charge_dollar": 418.37, "additional_payer_notes": "177.30% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ Indemnity", "methodology": "fee schedule", "standard_charge_dollar": 418.37, "additional_payer_notes": "177.30% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ PPO", "methodology": "fee schedule", "standard_charge_dollar": 418.37, "additional_payer_notes": "177.30% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon Medicare", "methodology": "fee schedule", "standard_charge_dollar": 235.97, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Military Tricare", "methodology": "fee schedule", "standard_charge_dollar": 188.78, "additional_payer_notes": "80.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 235.97, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 235.97, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC All Payer (02-01-2023 to 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 3057.0 }, { "payer_name": "UHC", "plan_name": "UHC Oxford (02-01-2023 to 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 2297.0 }, { "payer_name": "UHC - Adhoc", "plan_name": "UHC - Adhoc All Payer", "methodology": "case rate", "standard_charge_dollar": 3245.0 }, { "payer_name": "UHC - Adhoc", "plan_name": "UHC - Adhoc Oxford", "methodology": "case rate", "standard_charge_dollar": 2367.0 }, { "payer_name": "Wellcare", "plan_name": "Wellcare Insurance Exchange", "methodology": "fee schedule", "standard_charge_dollar": 318.56, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 235.97, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellchoice", "plan_name": "WELLCHOICE HMO of NJ (Empire) Commercial (HMO / HMO POS, PPO)", "methodology": "case rate", "standard_charge_dollar": 1715.0 }, { "payer_name": "Wellchoice", "plan_name": "WELLCHOICE HMO of NJ (Empire) Commercial (Indemnity)", "methodology": "case rate", "standard_charge_dollar": 1978.0 }, { "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup Medicare", "methodology": "fee schedule", "standard_charge_dollar": 235.97, "additional_payer_notes": "100.00% of Medicare Rates" } ] } ] }, { "description": "Remove Armpit Lymph Nodes", "code_information": [ { "code": "38745", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 23085.0, "discounted_cash": 7147.0, "minimum": 1715.0, "maximum": 18468.0, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 15151.75, "additional_payer_notes": "212.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medical Rental Network", "methodology": "fee schedule", "standard_charge_dollar": 15151.75, "additional_payer_notes": "212.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 7147.05, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "ALLY-ALIGN (FKA SPARTAN PLAN NJ, INC.)", "plan_name": "ALLY-ALIGN (FKA SPARTAN PLAN NJ, INC.)", "methodology": "fee schedule", "standard_charge_dollar": 7504.4, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Americhoice (UHC)", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 7147.05, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Amerihealth", "plan_name": "Amerihealth Medicare", "methodology": "fee schedule", "standard_charge_dollar": 7147.05, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 10502.59, "additional_payer_notes": "146.95% of Medicare Rates" }, { "payer_name": "Clover Health", "plan_name": "Clover Medicare", "methodology": "fee schedule", "standard_charge_dollar": 7147.05, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Coventry", "plan_name": "Coventry Auto", "methodology": "fee schedule", "standard_charge_dollar": 14294.1, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Coventry", "plan_name": "Coventry Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 14294.1, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "fee schedule", "standard_charge_dollar": 10005.87, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Fairprice Healthcare Holdings", "plan_name": "Fairprice Healthcare Holdings", "methodology": "fee schedule", "standard_charge_dollar": 11435.28, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ HMO POS", "methodology": "fee schedule", "standard_charge_dollar": 12671.72, "additional_payer_notes": "177.30% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ Indemnity", "methodology": "fee schedule", "standard_charge_dollar": 12671.72, "additional_payer_notes": "177.30% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ PPO", "methodology": "fee schedule", "standard_charge_dollar": 12671.72, "additional_payer_notes": "177.30% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon Medicare", "methodology": "fee schedule", "standard_charge_dollar": 7147.05, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Military Tricare", "methodology": "fee schedule", "standard_charge_dollar": 5717.64, "additional_payer_notes": "80.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 7147.05, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 7147.05, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC All Payer (02-01-2023 to 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 6624.0 }, { "payer_name": "UHC", "plan_name": "UHC Oxford (02-01-2023 to 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 6317.0 }, { "payer_name": "UHC - Adhoc", "plan_name": "UHC - Adhoc All Payer", "methodology": "case rate", "standard_charge_dollar": 7031.0 }, { "payer_name": "UHC - Adhoc", "plan_name": "UHC - Adhoc Oxford", "methodology": "case rate", "standard_charge_dollar": 6510.0 }, { "payer_name": "Wellcare", "plan_name": "Wellcare Insurance Exchange", "methodology": "fee schedule", "standard_charge_dollar": 9648.52, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 7147.05, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellchoice", "plan_name": "WELLCHOICE HMO of NJ (Empire) Commercial (HMO / HMO POS, PPO)", "methodology": "case rate", "standard_charge_dollar": 1715.0 }, { "payer_name": "Wellchoice", "plan_name": "WELLCHOICE HMO of NJ (Empire) Commercial (Indemnity)", "methodology": "case rate", "standard_charge_dollar": 1978.0 }, { "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup Medicare", "methodology": "fee schedule", "standard_charge_dollar": 7147.05, "additional_payer_notes": "100.00% of Medicare Rates" } ] } ] }, { "description": "Optx Acromclv Dislc Aqt/Chrn", "code_information": [ { "code": "23550", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 34083.0, "discounted_cash": 8578.0, "minimum": 1715.0, "maximum": 27266.4, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 18186.06, "additional_payer_notes": "212.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medical Rental Network", "methodology": "fee schedule", "standard_charge_dollar": 18186.06, "additional_payer_notes": "212.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 8578.33, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "ALLY-ALIGN (FKA SPARTAN PLAN NJ, INC.)", "plan_name": "ALLY-ALIGN (FKA SPARTAN PLAN NJ, INC.)", "methodology": "fee schedule", "standard_charge_dollar": 9007.25, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Americhoice (UHC)", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 8578.33, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Amerihealth", "plan_name": "Amerihealth Medicare", "methodology": "fee schedule", "standard_charge_dollar": 8578.33, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 12605.86, "additional_payer_notes": "146.95% of Medicare Rates" }, { "payer_name": "Clover Health", "plan_name": "Clover Medicare", "methodology": "fee schedule", "standard_charge_dollar": 8578.33, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Coventry", "plan_name": "Coventry Auto", "methodology": "fee schedule", "standard_charge_dollar": 17156.66, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Coventry", "plan_name": "Coventry Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 17156.66, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "fee schedule", "standard_charge_dollar": 12009.66, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Fairprice Healthcare Holdings", "plan_name": "Fairprice Healthcare Holdings", "methodology": "fee schedule", "standard_charge_dollar": 13725.33, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ HMO POS", "methodology": "fee schedule", "standard_charge_dollar": 15209.38, "additional_payer_notes": "177.30% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ Indemnity", "methodology": "fee schedule", "standard_charge_dollar": 15209.38, "additional_payer_notes": "177.30% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ PPO", "methodology": "fee schedule", "standard_charge_dollar": 15209.38, "additional_payer_notes": "177.30% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon Medicare", "methodology": "fee schedule", "standard_charge_dollar": 8578.33, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Military Tricare", "methodology": "fee schedule", "standard_charge_dollar": 6862.66, "additional_payer_notes": "80.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 8578.33, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 8578.33, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC All Payer (02-01-2023 to 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 6624.0 }, { "payer_name": "UHC", "plan_name": "UHC Oxford (02-01-2023 to 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 6317.0 }, { "payer_name": "UHC - Adhoc", "plan_name": "UHC - Adhoc All Payer", "methodology": "case rate", "standard_charge_dollar": 7031.0 }, { "payer_name": "UHC - Adhoc", "plan_name": "UHC - Adhoc Oxford", "methodology": "case rate", "standard_charge_dollar": 6510.0 }, { "payer_name": "Wellcare", "plan_name": "Wellcare Insurance Exchange", "methodology": "fee schedule", "standard_charge_dollar": 11580.75, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 8578.33, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellchoice", "plan_name": "WELLCHOICE HMO of NJ (Empire) Commercial (HMO / HMO POS, PPO)", "methodology": "case rate", "standard_charge_dollar": 1715.0 }, { "payer_name": "Wellchoice", "plan_name": "WELLCHOICE HMO of NJ (Empire) Commercial (Indemnity)", "methodology": "case rate", "standard_charge_dollar": 1978.0 }, { "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup Medicare", "methodology": "fee schedule", "standard_charge_dollar": 8578.33, "additional_payer_notes": "100.00% of Medicare Rates" } ] } ] }, { "description": "MASTECTOMY FOR MALIGNANCY WITHOUT CCMCC", "code_information": [ { "code": "583", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 21484.0, "minimum": 8605.32, "maximum": 38887.307, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "case rate", "standard_charge_dollar": 38887.31, "additional_payer_notes": "181.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medical Rental Network", "methodology": "case rate", "standard_charge_dollar": 38887.31, "additional_payer_notes": "181.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "case rate", "standard_charge_dollar": 17558.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "ALLY-ALIGN (FKA SPARTAN PLAN NJ, INC.)", "plan_name": "ALLY-ALIGN (FKA SPARTAN PLAN NJ, INC.)", "methodology": "case rate", "standard_charge_dollar": 22558.94, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Americhoice (UHC)", "plan_name": "UHC Medicare", "methodology": "case rate", "standard_charge_dollar": 17558.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Amerihealth", "plan_name": "Amerihealth Medicare", "methodology": "case rate", "standard_charge_dollar": 17558.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Commercial", "methodology": "case rate", "standard_charge_dollar": 25227.97 }, { "payer_name": "Clover Health", "plan_name": "Clover Medicare", "methodology": "case rate", "standard_charge_dollar": 17558.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Coventry", "plan_name": "Coventry Auto", "methodology": "case rate", "standard_charge_dollar": 36523.99, "additional_payer_notes": "170.00% of Medicare Rates" }, { "payer_name": "Coventry", "plan_name": "Coventry Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 36523.99, "additional_payer_notes": "170.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "case rate", "standard_charge_dollar": 27930.11, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Fairprice Healthcare Holdings", "plan_name": "Fairprice Healthcare Holdings", "methodology": "case rate", "standard_charge_dollar": 34375.52, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon Medicare", "methodology": "case rate", "standard_charge_dollar": 17558.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon NJ Health Medicaid", "methodology": "case rate", "standard_charge_dollar": 8605.32 }, { "payer_name": "Humana", "plan_name": "Humana Military Tricare", "methodology": "case rate", "standard_charge_dollar": 17187.76, "additional_payer_notes": "80.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 21484.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 36450.9 }, { "payer_name": "UBH", "plan_name": "UBH Medicare", "methodology": "case rate", "standard_charge_dollar": 17558.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC All Payer (02-01-2023 to 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 29066.49 }, { "payer_name": "UHC", "plan_name": "UHC Oxford (02-01-2023 to 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 25331.44 }, { "payer_name": "UHC - Adhoc", "plan_name": "UHC - Adhoc All Payer", "methodology": "case rate", "standard_charge_dollar": 30854.69 }, { "payer_name": "UHC - Adhoc", "plan_name": "UHC - Adhoc Oxford", "methodology": "case rate", "standard_charge_dollar": 26103.97 }, { "payer_name": "Wellcare", "plan_name": "Wellcare Insurance Exchange", "methodology": "case rate", "standard_charge_dollar": 29004.35, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "case rate", "standard_charge_dollar": 17558.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup Medicare", "methodology": "case rate", "standard_charge_dollar": 17558.3, "additional_payer_notes": "100.00% of Medicare Rates" } ] } ] }, { "description": "Hc Blood Culture For Bacteria", "code_information": [ { "code": "87040", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 98.0, "discounted_cash": 10.0, "minimum": 6.19, "maximum": 83.3, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 21.88, "additional_payer_notes": "212.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medical Rental Network", "methodology": "fee schedule", "standard_charge_dollar": 21.88, "additional_payer_notes": "212.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 10.32, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "ALLY-ALIGN (FKA SPARTAN PLAN NJ, INC.)", "plan_name": "ALLY-ALIGN (FKA SPARTAN PLAN NJ, INC.)", "methodology": "fee schedule", "standard_charge_dollar": 10.84, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Americhoice (UHC)", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 10.32, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Amerihealth", "plan_name": "Amerihealth Medicare", "methodology": "fee schedule", "standard_charge_dollar": 10.32, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 14.96, "additional_payer_notes": "Laboratory - 145.00% of Medicare Rates" }, { "payer_name": "Clover Health", "plan_name": "Clover Medicare", "methodology": "fee schedule", "standard_charge_dollar": 10.32, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Coventry", "plan_name": "Coventry Auto", "methodology": "fee schedule", "standard_charge_dollar": 20.64, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Coventry", "plan_name": "Coventry Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 20.64, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "fee schedule", "standard_charge_dollar": 14.45, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Fairprice Healthcare Holdings", "plan_name": "Fairprice Healthcare Holdings", "methodology": "fee schedule", "standard_charge_dollar": 12.38, "additional_payer_notes": "Laboratory - 120.00% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ HMO POS", "methodology": "fee schedule", "standard_charge_dollar": 69.19, "additional_payer_notes": "177.30% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ Indemnity", "methodology": "fee schedule", "standard_charge_dollar": 69.19, "additional_payer_notes": "177.30% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ PPO", "methodology": "fee schedule", "standard_charge_dollar": 69.19, "additional_payer_notes": "177.30% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon Medicare", "methodology": "fee schedule", "standard_charge_dollar": 10.32, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Military Tricare", "methodology": "fee schedule", "standard_charge_dollar": 8.26, "additional_payer_notes": "80.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 10.32, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 10.32, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC All Payer (02-01-2023 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 6.19 }, { "payer_name": "UHC", "plan_name": "UHC Medicaid (02/01/2023 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 8.26 }, { "payer_name": "UHC", "plan_name": "UHC Oxford (02-01-2023 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 6.19 }, { "payer_name": "UHC - Adhoc", "plan_name": "UHC - Adhoc All Payer", "methodology": "fee schedule", "standard_charge_dollar": 10.32 }, { "payer_name": "UHC - Adhoc", "plan_name": "UHC - Adhoc Oxford", "methodology": "fee schedule", "standard_charge_dollar": 10.32 }, { "payer_name": "Wellcare", "plan_name": "Wellcare Insurance Exchange", "methodology": "fee schedule", "standard_charge_dollar": 13.93, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 10.32, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup Medicaid", "methodology": "percent of total billed charges", "standard_charge_percentage": 19.09, "median_amount": 18.28, "10th_percentile": 10.32, "90th_percentile": 36.55, "count": "28" }, { "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup Medicare", "methodology": "fee schedule", "standard_charge_dollar": 10.32, "additional_payer_notes": "100.00% of Medicare Rates" } ] } ] }, { "description": "DISORDERS OF PERSONALITY AND IMPULSE CONTROL", "code_information": [ { "code": "883", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 24280.0, "minimum": 1350.0, "maximum": 43947.1801, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "case rate", "standard_charge_dollar": 43947.18, "additional_payer_notes": "181.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medical Rental Network", "methodology": "case rate", "standard_charge_dollar": 43947.18, "additional_payer_notes": "181.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "case rate", "standard_charge_dollar": 19803.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "ALLY-ALIGN (FKA SPARTAN PLAN NJ, INC.)", "plan_name": "ALLY-ALIGN (FKA SPARTAN PLAN NJ, INC.)", "methodology": "case rate", "standard_charge_dollar": 25494.22, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Americhoice (UHC)", "plan_name": "UHC Medicare", "methodology": "case rate", "standard_charge_dollar": 19803.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Amerihealth", "plan_name": "Amerihealth Medicare", "methodology": "case rate", "standard_charge_dollar": 19803.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Commercial", "methodology": "case rate", "standard_charge_dollar": 28766.97 }, { "payer_name": "Clover Health", "plan_name": "Clover Medicare", "methodology": "case rate", "standard_charge_dollar": 19803.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Coventry", "plan_name": "Coventry Auto", "methodology": "case rate", "standard_charge_dollar": 41276.36, "additional_payer_notes": "170.00% of Medicare Rates" }, { "payer_name": "Coventry", "plan_name": "Coventry Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 41276.36, "additional_payer_notes": "170.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "case rate", "standard_charge_dollar": 31564.27, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Fairprice Healthcare Holdings", "plan_name": "Fairprice Healthcare Holdings", "methodology": "case rate", "standard_charge_dollar": 38848.34, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon Medicare", "methodology": "case rate", "standard_charge_dollar": 19803.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon NJ Health Medicaid", "methodology": "per diem", "standard_charge_dollar": 1350.0 }, { "payer_name": "Humana", "plan_name": "Humana Military Tricare", "methodology": "case rate", "standard_charge_dollar": 19424.17, "additional_payer_notes": "80.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 24280.21, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 16068.0 }, { "payer_name": "UBH", "plan_name": "UBH Medicare", "methodology": "case rate", "standard_charge_dollar": 19803.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC All Payer (02-01-2023 to 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 33143.95 }, { "payer_name": "UHC", "plan_name": "UHC Oxford (02-01-2023 to 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 28884.95 }, { "payer_name": "UHC - Adhoc", "plan_name": "UHC - Adhoc All Payer", "methodology": "case rate", "standard_charge_dollar": 35183.01 }, { "payer_name": "UHC - Adhoc", "plan_name": "UHC - Adhoc Oxford", "methodology": "case rate", "standard_charge_dollar": 29765.85 }, { "payer_name": "Wellcare", "plan_name": "Wellcare Insurance Exchange", "methodology": "case rate", "standard_charge_dollar": 32778.28, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "case rate", "standard_charge_dollar": 19803.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup Medicare", "methodology": "case rate", "standard_charge_dollar": 19803.1, "additional_payer_notes": "100.00% of Medicare Rates" } ] } ] }, { "description": "Deep Muscle Biopsy", "code_information": [ { "code": "20205", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 13674.0, "discounted_cash": 3433.0, "minimum": 1715.0, "maximum": 10939.2, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 7280.0, "additional_payer_notes": "212.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medical Rental Network", "methodology": "fee schedule", "standard_charge_dollar": 7280.0, "additional_payer_notes": "212.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3433.96, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "ALLY-ALIGN (FKA SPARTAN PLAN NJ, INC.)", "plan_name": "ALLY-ALIGN (FKA SPARTAN PLAN NJ, INC.)", "methodology": "fee schedule", "standard_charge_dollar": 3605.66, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Americhoice (UHC)", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3433.96, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Amerihealth", "plan_name": "Amerihealth Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3433.96, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 5046.2, "additional_payer_notes": "146.95% of Medicare Rates" }, { "payer_name": "Clover Health", "plan_name": "Clover Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3433.96, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Coventry", "plan_name": "Coventry Auto", "methodology": "fee schedule", "standard_charge_dollar": 6867.92, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Coventry", "plan_name": "Coventry Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 6867.92, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "fee schedule", "standard_charge_dollar": 4807.54, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Fairprice Healthcare Holdings", "plan_name": "Fairprice Healthcare Holdings", "methodology": "fee schedule", "standard_charge_dollar": 5494.34, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ HMO POS", "methodology": "fee schedule", "standard_charge_dollar": 6088.41, "additional_payer_notes": "177.30% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ Indemnity", "methodology": "fee schedule", "standard_charge_dollar": 6088.41, "additional_payer_notes": "177.30% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ PPO", "methodology": "fee schedule", "standard_charge_dollar": 6088.41, "additional_payer_notes": "177.30% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3433.96, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Military Tricare", "methodology": "fee schedule", "standard_charge_dollar": 2747.17, "additional_payer_notes": "80.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3433.96, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 3433.96, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC All Payer (02-01-2023 to 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 3912.0 }, { "payer_name": "UHC", "plan_name": "UHC Oxford (02-01-2023 to 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 3676.0 }, { "payer_name": "UHC - Adhoc", "plan_name": "UHC - Adhoc All Payer", "methodology": "case rate", "standard_charge_dollar": 4153.0 }, { "payer_name": "UHC - Adhoc", "plan_name": "UHC - Adhoc Oxford", "methodology": "case rate", "standard_charge_dollar": 3788.0 }, { "payer_name": "Wellcare", "plan_name": "Wellcare Insurance Exchange", "methodology": "fee schedule", "standard_charge_dollar": 4635.85, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3433.96, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellchoice", "plan_name": "WELLCHOICE HMO of NJ (Empire) Commercial (HMO / HMO POS, PPO)", "methodology": "case rate", "standard_charge_dollar": 1715.0 }, { "payer_name": "Wellchoice", "plan_name": "WELLCHOICE HMO of NJ (Empire) Commercial (Indemnity)", "methodology": "case rate", "standard_charge_dollar": 1978.0 }, { "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3433.96, "additional_payer_notes": "100.00% of Medicare Rates" } ] } ] }, { "description": "UNLISTED LAPS PX UTERUS", "code_information": [ { "code": "58578", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 8655.0, "discounted_cash": 7147.0, "minimum": 1652.2395, "maximum": 8655.0, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 8655.0, "additional_payer_notes": "212.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medical Rental Network", "methodology": "fee schedule", "standard_charge_dollar": 8655.0, "additional_payer_notes": "212.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 7147.05, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "ALLY-ALIGN (FKA SPARTAN PLAN NJ, INC.)", "plan_name": "ALLY-ALIGN (FKA SPARTAN PLAN NJ, INC.)", "methodology": "fee schedule", "standard_charge_dollar": 7504.4, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Americhoice (UHC)", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 7147.05, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Amerihealth", "plan_name": "Amerihealth Medicare", "methodology": "fee schedule", "standard_charge_dollar": 7147.05, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 8655.0, "additional_payer_notes": "146.95% of Medicare Rates" }, { "payer_name": "Clover Health", "plan_name": "Clover Medicare", "methodology": "fee schedule", "standard_charge_dollar": 7147.05, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Coventry", "plan_name": "Coventry Auto", "methodology": "fee schedule", "standard_charge_dollar": 8655.0, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Coventry", "plan_name": "Coventry Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 8655.0, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "fee schedule", "standard_charge_dollar": 8655.0, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Fairprice Healthcare Holdings", "plan_name": "Fairprice Healthcare Holdings", "methodology": "fee schedule", "standard_charge_dollar": 8655.0, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ HMO POS", "methodology": "fee schedule", "standard_charge_dollar": 8655.0, "additional_payer_notes": "177.30% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ Indemnity", "methodology": "fee schedule", "standard_charge_dollar": 8655.0, "additional_payer_notes": "177.30% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ PPO", "methodology": "fee schedule", "standard_charge_dollar": 8655.0, "additional_payer_notes": "177.30% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon Medicare", "methodology": "fee schedule", "standard_charge_dollar": 7147.05, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Military Tricare", "methodology": "fee schedule", "standard_charge_dollar": 5717.64, "additional_payer_notes": "80.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 7147.05, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 7147.05, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC All Payer (02-01-2023 to 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 5667.0 }, { "payer_name": "UHC", "plan_name": "UHC Oxford (02-01-2023 to 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 5169.0 }, { "payer_name": "UHC - Adhoc", "plan_name": "UHC - Adhoc All Payer", "methodology": "case rate", "standard_charge_dollar": 6016.0 }, { "payer_name": "UHC - Adhoc", "plan_name": "UHC - Adhoc Oxford", "methodology": "case rate", "standard_charge_dollar": 5327.0 }, { "payer_name": "Wellcare", "plan_name": "Wellcare Insurance Exchange", "methodology": "fee schedule", "standard_charge_dollar": 8655.0, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 7147.05, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellchoice", "plan_name": "WELLCHOICE HMO of NJ (Empire) Commercial (HMO / HMO POS, PPO)", "methodology": "case rate", "standard_charge_dollar": 1715.0 }, { "payer_name": "Wellchoice", "plan_name": "WELLCHOICE HMO of NJ (Empire) Commercial (Indemnity)", "methodology": "case rate", "standard_charge_dollar": 1978.0 }, { "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup Medicare", "methodology": "fee schedule", "standard_charge_dollar": 7147.05, "additional_payer_notes": "100.00% of Medicare Rates" } ] } ] }, { "description": "CORONARY BYPASS W AMI OR COMPLEX PDX - SOI : 1", "code_information": [ { "code": "1651", "type": "APR-DRG" } ], "standard_charges": [ { "setting": "inpatient", "minimum": 48363.15, "maximum": 53199.46, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Better Health - Medi Medi", "methodology": "case rate", "standard_charge_dollar": 53199.46, "additional_payer_notes": "110% of State Medicaid Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Better Health Medicaid", "methodology": "case rate", "standard_charge_dollar": 53199.46, "additional_payer_notes": "110% of State Medicaid Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "case rate", "standard_charge_dollar": 48363.15, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "UBH", "plan_name": "UBH Medicaid", "methodology": "case rate", "standard_charge_dollar": 48363.15, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicaid (02/01/2023 to 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 49330.41, "additional_payer_notes": "102% of State Medicaid Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicaid", "methodology": "case rate", "standard_charge_dollar": 48363.15, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup Medicaid", "methodology": "case rate", "standard_charge_dollar": 48363.15, "additional_payer_notes": "100% of State Medicaid Rates" } ] } ] }, { "description": "KIDNEY AND URETER PROCEDURES FOR NEOPLASM WITHOUT CCMCC", "code_information": [ { "code": "658", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 19490.0, "minimum": 9781.13, "maximum": 35276.9905, "payers_information": [ { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "case rate", "standard_charge_dollar": 25337.07, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Fairprice Healthcare Holdings", "plan_name": "Fairprice Healthcare Holdings", "methodology": "case rate", "standard_charge_dollar": 31184.08, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon Medicare", "methodology": "case rate", "standard_charge_dollar": 15956.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon NJ Health Medicaid", "methodology": "case rate", "standard_charge_dollar": 9781.13 }, { "payer_name": "Humana", "plan_name": "Humana Military Tricare", "methodology": "case rate", "standard_charge_dollar": 15592.04, "additional_payer_notes": "80.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 19490.05, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 26957.4 }, { "payer_name": "UBH", "plan_name": "UBH Medicare", "methodology": "case rate", "standard_charge_dollar": 15956.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC All Payer (02-01-2023 to 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 26157.14 }, { "payer_name": "UHC", "plan_name": "UHC Oxford (02-01-2023 to 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 22795.94 }, { "payer_name": "UHC - Adhoc", "plan_name": "UHC - Adhoc All Payer", "methodology": "case rate", "standard_charge_dollar": 27766.36 }, { "payer_name": "UHC - Adhoc", "plan_name": "UHC - Adhoc Oxford", "methodology": "case rate", "standard_charge_dollar": 23491.15 }, { "payer_name": "Wellcare", "plan_name": "Wellcare Insurance Exchange", "methodology": "case rate", "standard_charge_dollar": 26311.57, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "case rate", "standard_charge_dollar": 15956.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup Medicare", "methodology": "case rate", "standard_charge_dollar": 15956.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "case rate", "standard_charge_dollar": 35276.99, "additional_payer_notes": "181.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medical Rental Network", "methodology": "case rate", "standard_charge_dollar": 35276.99, "additional_payer_notes": "181.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "case rate", "standard_charge_dollar": 15956.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "ALLY-ALIGN (FKA SPARTAN PLAN NJ, INC.)", "plan_name": "ALLY-ALIGN (FKA SPARTAN PLAN NJ, INC.)", "methodology": "case rate", "standard_charge_dollar": 20464.55, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Americhoice (UHC)", "plan_name": "UHC Medicare", "methodology": "case rate", "standard_charge_dollar": 15956.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Amerihealth", "plan_name": "Amerihealth Medicare", "methodology": "case rate", "standard_charge_dollar": 15956.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Commercial", "methodology": "case rate", "standard_charge_dollar": 22702.83 }, { "payer_name": "Clover Health", "plan_name": "Clover Medicare", "methodology": "case rate", "standard_charge_dollar": 15956.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Coventry", "plan_name": "Coventry Auto", "methodology": "case rate", "standard_charge_dollar": 33133.09, "additional_payer_notes": "170.00% of Medicare Rates" }, { "payer_name": "Coventry", "plan_name": "Coventry Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 33133.09, "additional_payer_notes": "170.00% of Medicare Rates" } ] } ] }, { "description": "COMBINED ANTERIOR AND POSTERIOR SPINAL FUSION WITHOUT CCMCC", "code_information": [ { "code": "455", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "minimum": 31221.67, "maximum": 97065.0, "payers_information": [ { "payer_name": "Horizon", "plan_name": "Horizon NJ Health Medicaid", "methodology": "case rate", "standard_charge_dollar": 31221.67 } ] } ] }, { "description": "Hc Inj Slct Cor Angio During Congenital Heart Cath", "code_information": [ { "code": "93563", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 2835.0, "minimum": 541.2015, "maximum": 2835.0, "payers_information": [ { "payer_name": "UHC", "plan_name": "UHC All Payer (02-01-2023 to 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 2835.0 }, { "payer_name": "UHC", "plan_name": "UHC Oxford (02-01-2023 to 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 2297.0 }, { "payer_name": "UHC - Adhoc", "plan_name": "UHC - Adhoc All Payer", "methodology": "case rate", "standard_charge_dollar": 2835.0 }, { "payer_name": "UHC - Adhoc", "plan_name": "UHC - Adhoc Oxford", "methodology": "case rate", "standard_charge_dollar": 2367.0 }, { "payer_name": "Wellchoice", "plan_name": "WELLCHOICE HMO of NJ (Empire) Commercial (HMO / HMO POS, PPO)", "methodology": "case rate", "standard_charge_dollar": 2472.0 }, { "payer_name": "Wellchoice", "plan_name": "WELLCHOICE HMO of NJ (Empire) Commercial (Indemnity)", "methodology": "case rate", "standard_charge_dollar": 2753.0 } ] } ] }, { "description": "Hc Assay Of Pregnanediol", "code_information": [ { "code": "84135", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 141.0, "discounted_cash": 21.0, "minimum": 12.76, "maximum": 119.85, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 45.09, "additional_payer_notes": "212.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medical Rental Network", "methodology": "fee schedule", "standard_charge_dollar": 45.09, "additional_payer_notes": "212.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 21.27, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "ALLY-ALIGN (FKA SPARTAN PLAN NJ, INC.)", "plan_name": "ALLY-ALIGN (FKA SPARTAN PLAN NJ, INC.)", "methodology": "fee schedule", "standard_charge_dollar": 22.33, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Americhoice (UHC)", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 21.27, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Amerihealth", "plan_name": "Amerihealth Medicare", "methodology": "fee schedule", "standard_charge_dollar": 21.27, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 30.84, "additional_payer_notes": "Laboratory - 145.00% of Medicare Rates" }, { "payer_name": "Clover Health", "plan_name": "Clover Medicare", "methodology": "fee schedule", "standard_charge_dollar": 21.27, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Coventry", "plan_name": "Coventry Auto", "methodology": "fee schedule", "standard_charge_dollar": 42.54, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Coventry", "plan_name": "Coventry Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 42.54, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "fee schedule", "standard_charge_dollar": 29.78, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Fairprice Healthcare Holdings", "plan_name": "Fairprice Healthcare Holdings", "methodology": "fee schedule", "standard_charge_dollar": 25.52, "additional_payer_notes": "Laboratory - 120.00% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ HMO POS", "methodology": "fee schedule", "standard_charge_dollar": 99.55, "additional_payer_notes": "177.30% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ Indemnity", "methodology": "fee schedule", "standard_charge_dollar": 99.55, "additional_payer_notes": "177.30% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ PPO", "methodology": "fee schedule", "standard_charge_dollar": 99.55, "additional_payer_notes": "177.30% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon Medicare", "methodology": "fee schedule", "standard_charge_dollar": 21.27, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Military Tricare", "methodology": "fee schedule", "standard_charge_dollar": 17.02, "additional_payer_notes": "80.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 21.27, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 21.27, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC All Payer (02-01-2023 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 12.76 }, { "payer_name": "UHC", "plan_name": "UHC Medicaid (02/01/2023 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 17.02 }, { "payer_name": "UHC", "plan_name": "UHC Oxford (02-01-2023 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 12.76 }, { "payer_name": "UHC - Adhoc", "plan_name": "UHC - Adhoc All Payer", "methodology": "fee schedule", "standard_charge_dollar": 21.27 }, { "payer_name": "UHC - Adhoc", "plan_name": "UHC - Adhoc Oxford", "methodology": "fee schedule", "standard_charge_dollar": 21.27 }, { "payer_name": "Wellcare", "plan_name": "Wellcare Insurance Exchange", "methodology": "fee schedule", "standard_charge_dollar": 28.71, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 21.27, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup Medicare", "methodology": "fee schedule", "standard_charge_dollar": 21.27, "additional_payer_notes": "100.00% of Medicare Rates" } ] } ] }, { "description": "MUSCULOSKELETAL MALIGNANCY & PATHOL FRACTURE DT MUSCSKEL MALIG - SOI : 4", "code_information": [ { "code": "3434", "type": "APR-DRG" } ], "standard_charges": [ { "setting": "inpatient", "minimum": 27613.58, "maximum": 30374.94, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Better Health - Medi Medi", "methodology": "case rate", "standard_charge_dollar": 30374.94, "additional_payer_notes": "110% of State Medicaid Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Better Health Medicaid", "methodology": "case rate", "standard_charge_dollar": 30374.94, "additional_payer_notes": "110% of State Medicaid Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "case rate", "standard_charge_dollar": 27613.58, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "UBH", "plan_name": "UBH Medicaid", "methodology": "case rate", "standard_charge_dollar": 27613.58, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicaid (02/01/2023 to 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 28165.85, "additional_payer_notes": "102% of State Medicaid Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicaid", "methodology": "case rate", "standard_charge_dollar": 27613.58, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup Medicaid", "methodology": "case rate", "standard_charge_dollar": 27613.58, "additional_payer_notes": "100% of State Medicaid Rates" } ] } ] }, { "description": "Hc Duplex Extrem Venous,Bilat", "code_information": [ { "code": "93970", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 1410.41, "discounted_cash": 282.0, "minimum": 225.656, "maximum": 1337.0, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 597.99, "additional_payer_notes": "212.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medical Rental Network", "methodology": "fee schedule", "standard_charge_dollar": 597.99, "additional_payer_notes": "212.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 282.07, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "ALLY-ALIGN (FKA SPARTAN PLAN NJ, INC.)", "plan_name": "ALLY-ALIGN (FKA SPARTAN PLAN NJ, INC.)", "methodology": "fee schedule", "standard_charge_dollar": 296.17, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Americhoice (UHC)", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 282.07, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Amerihealth", "plan_name": "Amerihealth Medicare", "methodology": "fee schedule", "standard_charge_dollar": 282.07, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 414.5, "additional_payer_notes": "146.95% of Medicare Rates" }, { "payer_name": "Clover Health", "plan_name": "Clover Medicare", "methodology": "fee schedule", "standard_charge_dollar": 282.07, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Coventry", "plan_name": "Coventry Auto", "methodology": "fee schedule", "standard_charge_dollar": 564.14, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Coventry", "plan_name": "Coventry Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 564.14, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "fee schedule", "standard_charge_dollar": 394.9, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Fairprice Healthcare Holdings", "plan_name": "Fairprice Healthcare Holdings", "methodology": "fee schedule", "standard_charge_dollar": 451.31, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ HMO POS", "methodology": "fee schedule", "standard_charge_dollar": 500.11, "additional_payer_notes": "177.30% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ Indemnity", "methodology": "fee schedule", "standard_charge_dollar": 500.11, "additional_payer_notes": "177.30% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ PPO", "methodology": "fee schedule", "standard_charge_dollar": 500.11, "additional_payer_notes": "177.30% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon Medicare", "methodology": "fee schedule", "standard_charge_dollar": 282.07, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon NJ Health Medicaid", "methodology": "percent of total billed charges", "standard_charge_percentage": 19.58, "median_amount": 276.16, "10th_percentile": 276.16, "90th_percentile": 276.16, "count": "16" }, { "payer_name": "Humana", "plan_name": "Humana Military Tricare", "methodology": "fee schedule", "standard_charge_dollar": 225.66, "additional_payer_notes": "80.00% of Medicare Rates" }, { "payer_name": "Keenan", "plan_name": "Keenan", "methodology": "percent of total billed charges", "standard_charge_percentage": 30.0, "median_amount": 423.12, "10th_percentile": 423.12, "90th_percentile": 423.12, "count": "1 through 10" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 282.07, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 282.07, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC All Payer (02-01-2023 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 1260.0 }, { "payer_name": "UHC", "plan_name": "UHC Medicaid (02/01/2023 to 12-31-2026)", "methodology": "percent of total billed charges", "standard_charge_percentage": 19.47, "median_amount": 284.66, "10th_percentile": 268.3, "90th_percentile": 284.66, "count": "1 through 10" }, { "payer_name": "UHC", "plan_name": "UHC Oxford (02-01-2023 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 1103.0 }, { "payer_name": "UHC - Adhoc", "plan_name": "UHC - Adhoc All Payer", "methodology": "fee schedule", "standard_charge_dollar": 1337.0 }, { "payer_name": "UHC - Adhoc", "plan_name": "UHC - Adhoc Oxford", "methodology": "fee schedule", "standard_charge_dollar": 1115.0 }, { "payer_name": "Wellcare", "plan_name": "Wellcare Insurance Exchange", "methodology": "fee schedule", "standard_charge_dollar": 380.79, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 282.07, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup Medicaid", "methodology": "percent of total billed charges", "standard_charge_percentage": 19.09, "median_amount": 263.04, "10th_percentile": 263.04, "90th_percentile": 284.66, "count": "1 through 10" }, { "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup Medicare", "methodology": "fee schedule", "standard_charge_dollar": 282.07, "additional_payer_notes": "100.00% of Medicare Rates" } ] } ] }, { "description": "Hc Assay Of Methadone - 80358 - 30100205", "code_information": [ { "code": "80358", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 51.0, "minimum": 9.7359, "maximum": 43.35, "payers_information": [ { "payer_name": "UHC", "plan_name": "UHC Medicaid (02/01/2023 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 16.48 } ] } ] }, { "description": "Hc Occup Thrp Eval, High Complexity, 60 Min", "code_information": [ { "code": "97167", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 480.45, "discounted_cash": 111.0, "minimum": 89.296, "maximum": 432.0, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 236.63, "additional_payer_notes": "212.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medical Rental Network", "methodology": "fee schedule", "standard_charge_dollar": 236.63, "additional_payer_notes": "212.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 111.62, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "ALLY-ALIGN (FKA SPARTAN PLAN NJ, INC.)", "plan_name": "ALLY-ALIGN (FKA SPARTAN PLAN NJ, INC.)", "methodology": "fee schedule", "standard_charge_dollar": 117.2, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Americhoice (UHC)", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 111.62, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Amerihealth", "plan_name": "Amerihealth Medicare", "methodology": "fee schedule", "standard_charge_dollar": 111.62, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 158.0, "additional_payer_notes": "A Indicator - 155.00% of Medicare Rates" }, { "payer_name": "Clover Health", "plan_name": "Clover Medicare", "methodology": "fee schedule", "standard_charge_dollar": 111.62, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Coventry", "plan_name": "Coventry Auto", "methodology": "fee schedule", "standard_charge_dollar": 223.24, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Coventry", "plan_name": "Coventry Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 223.24, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "fee schedule", "standard_charge_dollar": 156.27, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Fairprice Healthcare Holdings", "plan_name": "Fairprice Healthcare Holdings", "methodology": "fee schedule", "standard_charge_dollar": 178.59 }, { "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ HMO POS", "methodology": "fee schedule", "standard_charge_dollar": 339.2, "additional_payer_notes": "177.30% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ Indemnity", "methodology": "fee schedule", "standard_charge_dollar": 339.2, "additional_payer_notes": "177.30% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ PPO", "methodology": "fee schedule", "standard_charge_dollar": 339.2, "additional_payer_notes": "177.30% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon Medicare", "methodology": "fee schedule", "standard_charge_dollar": 111.62, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Military Tricare", "methodology": "fee schedule", "standard_charge_dollar": 89.3, "additional_payer_notes": "80.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 111.62, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 111.62, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC All Payer (02-01-2023 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 407.0 }, { "payer_name": "UHC", "plan_name": "UHC Medicaid (02/01/2023 to 12-31-2026)", "methodology": "percent of total billed charges", "standard_charge_percentage": 19.47, "median_amount": 112.34, "10th_percentile": 112.34, "90th_percentile": 112.34, "count": "1 through 10" }, { "payer_name": "UHC", "plan_name": "UHC Oxford (02-01-2023 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 357.0 }, { "payer_name": "UHC - Adhoc", "plan_name": "UHC - Adhoc All Payer", "methodology": "fee schedule", "standard_charge_dollar": 432.0 }, { "payer_name": "UHC - Adhoc", "plan_name": "UHC - Adhoc Oxford", "methodology": "fee schedule", "standard_charge_dollar": 368.0 }, { "payer_name": "Wellcare", "plan_name": "Wellcare Insurance Exchange", "methodology": "fee schedule", "standard_charge_dollar": 150.69, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 111.62, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup Medicare", "methodology": "fee schedule", "standard_charge_dollar": 111.62, "additional_payer_notes": "100.00% of Medicare Rates" } ] } ] }, { "description": "REVISION OF HIP OR KNEE REPLACEMENT WITH CC", "code_information": [ { "code": "467", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 42311.0, "minimum": 21670.34, "maximum": 76584.3037, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "case rate", "standard_charge_dollar": 76584.3, "additional_payer_notes": "181.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medical Rental Network", "methodology": "case rate", "standard_charge_dollar": 76584.3, "additional_payer_notes": "181.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "case rate", "standard_charge_dollar": 34281.9, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "ALLY-ALIGN (FKA SPARTAN PLAN NJ, INC.)", "plan_name": "ALLY-ALIGN (FKA SPARTAN PLAN NJ, INC.)", "methodology": "case rate", "standard_charge_dollar": 44427.36, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Americhoice (UHC)", "plan_name": "UHC Medicare", "methodology": "case rate", "standard_charge_dollar": 34281.9, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Amerihealth", "plan_name": "Amerihealth Medicare", "methodology": "case rate", "standard_charge_dollar": 34281.9, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Commercial", "methodology": "case rate", "standard_charge_dollar": 51594.16 }, { "payer_name": "Clover Health", "plan_name": "Clover Medicare", "methodology": "case rate", "standard_charge_dollar": 34281.9, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Coventry", "plan_name": "Coventry Auto", "methodology": "case rate", "standard_charge_dollar": 71930.01, "additional_payer_notes": "170.00% of Medicare Rates" }, { "payer_name": "Coventry", "plan_name": "Coventry Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 71930.01, "additional_payer_notes": "170.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "case rate", "standard_charge_dollar": 55005.3, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Fairprice Healthcare Holdings", "plan_name": "Fairprice Healthcare Holdings", "methodology": "case rate", "standard_charge_dollar": 67698.83, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon Medicare", "methodology": "case rate", "standard_charge_dollar": 34281.9, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon NJ Health Medicaid", "methodology": "case rate", "standard_charge_dollar": 21670.34 }, { "payer_name": "Humana", "plan_name": "Humana Military Tricare", "methodology": "case rate", "standard_charge_dollar": 33849.42, "additional_payer_notes": "80.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 42311.77, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 45823.8 }, { "payer_name": "UBH", "plan_name": "UBH Medicare", "methodology": "case rate", "standard_charge_dollar": 34281.9, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC All Payer (02-01-2023 to 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 59444.37 }, { "payer_name": "UHC", "plan_name": "UHC Oxford (02-01-2023 to 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 51805.75 }, { "payer_name": "UHC - Adhoc", "plan_name": "UHC - Adhoc All Payer", "methodology": "case rate", "standard_charge_dollar": 63101.45 }, { "payer_name": "UHC - Adhoc", "plan_name": "UHC - Adhoc Oxford", "methodology": "case rate", "standard_charge_dollar": 53385.67 }, { "payer_name": "Wellcare", "plan_name": "Wellcare Insurance Exchange", "methodology": "case rate", "standard_charge_dollar": 57120.89, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "case rate", "standard_charge_dollar": 34281.9, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup Medicare", "methodology": "case rate", "standard_charge_dollar": 34281.9, "additional_payer_notes": "100.00% of Medicare Rates" } ] } ] }, { "description": "Hc Venous Cutdown >1 Y/O", "code_information": [ { "code": "36425", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 1297.74, "discounted_cash": 528.0, "minimum": 247.7386, "maximum": 1297.74, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 1119.61, "additional_payer_notes": "212.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medical Rental Network", "methodology": "fee schedule", "standard_charge_dollar": 1119.61, "additional_payer_notes": "212.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 528.12, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "ALLY-ALIGN (FKA SPARTAN PLAN NJ, INC.)", "plan_name": "ALLY-ALIGN (FKA SPARTAN PLAN NJ, INC.)", "methodology": "fee schedule", "standard_charge_dollar": 554.53, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Americhoice (UHC)", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 528.12, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Amerihealth", "plan_name": "Amerihealth Medicare", "methodology": "fee schedule", "standard_charge_dollar": 528.12, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 776.07, "additional_payer_notes": "146.95% of Medicare Rates" }, { "payer_name": "Clover Health", "plan_name": "Clover Medicare", "methodology": "fee schedule", "standard_charge_dollar": 528.12, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Coventry", "plan_name": "Coventry Auto", "methodology": "fee schedule", "standard_charge_dollar": 1056.24, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Coventry", "plan_name": "Coventry Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 1056.24, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "fee schedule", "standard_charge_dollar": 739.37, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Fairprice Healthcare Holdings", "plan_name": "Fairprice Healthcare Holdings", "methodology": "fee schedule", "standard_charge_dollar": 844.99, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ HMO POS", "methodology": "fee schedule", "standard_charge_dollar": 936.36, "additional_payer_notes": "177.30% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ Indemnity", "methodology": "fee schedule", "standard_charge_dollar": 936.36, "additional_payer_notes": "177.30% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ PPO", "methodology": "fee schedule", "standard_charge_dollar": 936.36, "additional_payer_notes": "177.30% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon Medicare", "methodology": "fee schedule", "standard_charge_dollar": 528.12, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Military Tricare", "methodology": "fee schedule", "standard_charge_dollar": 422.5, "additional_payer_notes": "80.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 528.12, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 528.12, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC All Payer (02-01-2023 to 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 1297.74 }, { "payer_name": "UHC", "plan_name": "UHC Oxford (02-01-2023 to 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 1297.74 }, { "payer_name": "UHC - Adhoc", "plan_name": "UHC - Adhoc All Payer", "methodology": "case rate", "standard_charge_dollar": 1297.74 }, { "payer_name": "UHC - Adhoc", "plan_name": "UHC - Adhoc Oxford", "methodology": "case rate", "standard_charge_dollar": 1297.74 }, { "payer_name": "Wellcare", "plan_name": "Wellcare Insurance Exchange", "methodology": "fee schedule", "standard_charge_dollar": 712.96, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 528.12, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup Medicare", "methodology": "fee schedule", "standard_charge_dollar": 528.12, "additional_payer_notes": "100.00% of Medicare Rates" } ] } ] }, { "description": "HYPERTENSION - SOI : 1", "code_information": [ { "code": "1991", "type": "APR-DRG" } ], "standard_charges": [ { "setting": "inpatient", "minimum": 6338.18, "maximum": 6971.99, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Better Health - Medi Medi", "methodology": "case rate", "standard_charge_dollar": 6971.99, "additional_payer_notes": "110% of State Medicaid Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Better Health Medicaid", "methodology": "case rate", "standard_charge_dollar": 6971.99, "additional_payer_notes": "110% of State Medicaid Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "case rate", "standard_charge_dollar": 6338.18, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "UBH", "plan_name": "UBH Medicaid", "methodology": "case rate", "standard_charge_dollar": 6338.18, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicaid (02/01/2023 to 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 6464.94, "additional_payer_notes": "102% of State Medicaid Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicaid", "methodology": "case rate", "standard_charge_dollar": 6338.18, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup Medicaid", "methodology": "case rate", "standard_charge_dollar": 6338.18, "additional_payer_notes": "100% of State Medicaid Rates" } ] } ] }, { "description": "Hc Tx Incomplete Abortion Any Trimester Surgical", "code_information": [ { "code": "59812", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 8801.45, "discounted_cash": 3826.0, "minimum": 1680.1968, "maximum": 11121.44, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 8113.13, "additional_payer_notes": "212.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medical Rental Network", "methodology": "fee schedule", "standard_charge_dollar": 8113.13, "additional_payer_notes": "212.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3826.95, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "ALLY-ALIGN (FKA SPARTAN PLAN NJ, INC.)", "plan_name": "ALLY-ALIGN (FKA SPARTAN PLAN NJ, INC.)", "methodology": "fee schedule", "standard_charge_dollar": 4018.3, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Americhoice (UHC)", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3826.95, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Amerihealth", "plan_name": "Amerihealth Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3826.95, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 5623.7, "additional_payer_notes": "146.95% of Medicare Rates" }, { "payer_name": "Clover Health", "plan_name": "Clover Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3826.95, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Coventry", "plan_name": "Coventry Auto", "methodology": "fee schedule", "standard_charge_dollar": 7653.9, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Coventry", "plan_name": "Coventry Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 7653.9, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "fee schedule", "standard_charge_dollar": 5357.73, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Fairprice Healthcare Holdings", "plan_name": "Fairprice Healthcare Holdings", "methodology": "fee schedule", "standard_charge_dollar": 6123.12, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ HMO POS", "methodology": "fee schedule", "standard_charge_dollar": 6785.18, "additional_payer_notes": "177.30% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ Indemnity", "methodology": "fee schedule", "standard_charge_dollar": 6785.18, "additional_payer_notes": "177.30% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ PPO", "methodology": "fee schedule", "standard_charge_dollar": 6785.18, "additional_payer_notes": "177.30% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3826.95, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Military Tricare", "methodology": "fee schedule", "standard_charge_dollar": 3061.56, "additional_payer_notes": "80.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3826.95, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 3826.95, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC All Payer (02-01-2023 to 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 4415.0 }, { "payer_name": "UHC", "plan_name": "UHC Oxford (02-01-2023 to 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 4020.0 }, { "payer_name": "UHC - Adhoc", "plan_name": "UHC - Adhoc All Payer", "methodology": "case rate", "standard_charge_dollar": 4687.0 }, { "payer_name": "UHC - Adhoc", "plan_name": "UHC - Adhoc Oxford", "methodology": "case rate", "standard_charge_dollar": 4143.0 }, { "payer_name": "Wellcare", "plan_name": "Wellcare Insurance Exchange", "methodology": "fee schedule", "standard_charge_dollar": 5166.38, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3826.95, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellchoice", "plan_name": "WELLCHOICE HMO of NJ (Empire) Commercial (HMO / HMO POS, PPO)", "methodology": "case rate", "standard_charge_dollar": 1715.0 }, { "payer_name": "Wellchoice", "plan_name": "WELLCHOICE HMO of NJ (Empire) Commercial (Indemnity)", "methodology": "case rate", "standard_charge_dollar": 1978.0 }, { "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3826.95, "additional_payer_notes": "100.00% of Medicare Rates" } ] } ] }, { "description": "ADRENAL AND PITUITARY PROCEDURES WITHOUT CCMCC", "code_information": [ { "code": "615", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 17727.0, "minimum": 9249.11, "maximum": 32087.1189, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "case rate", "standard_charge_dollar": 32087.12, "additional_payer_notes": "181.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medical Rental Network", "methodology": "case rate", "standard_charge_dollar": 32087.12, "additional_payer_notes": "181.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "case rate", "standard_charge_dollar": 14541.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "ALLY-ALIGN (FKA SPARTAN PLAN NJ, INC.)", "plan_name": "ALLY-ALIGN (FKA SPARTAN PLAN NJ, INC.)", "methodology": "case rate", "standard_charge_dollar": 18614.07, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Americhoice (UHC)", "plan_name": "UHC Medicare", "methodology": "case rate", "standard_charge_dollar": 14541.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Amerihealth", "plan_name": "Amerihealth Medicare", "methodology": "case rate", "standard_charge_dollar": 14541.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Commercial", "methodology": "case rate", "standard_charge_dollar": 20471.76 }, { "payer_name": "Clover Health", "plan_name": "Clover Medicare", "methodology": "case rate", "standard_charge_dollar": 14541.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Coventry", "plan_name": "Coventry Auto", "methodology": "case rate", "standard_charge_dollar": 30137.07, "additional_payer_notes": "170.00% of Medicare Rates" }, { "payer_name": "Coventry", "plan_name": "Coventry Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 30137.07, "additional_payer_notes": "170.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "case rate", "standard_charge_dollar": 23046.0, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Fairprice Healthcare Holdings", "plan_name": "Fairprice Healthcare Holdings", "methodology": "case rate", "standard_charge_dollar": 28364.3, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon Medicare", "methodology": "case rate", "standard_charge_dollar": 14541.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon NJ Health Medicaid", "methodology": "case rate", "standard_charge_dollar": 9249.11 }, { "payer_name": "Humana", "plan_name": "Humana Military Tricare", "methodology": "case rate", "standard_charge_dollar": 14182.15, "additional_payer_notes": "80.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 17727.69, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 21609.7 }, { "payer_name": "UBH", "plan_name": "UBH Medicare", "methodology": "case rate", "standard_charge_dollar": 14541.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC All Payer (02-01-2023 to 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 23586.6 }, { "payer_name": "UHC", "plan_name": "UHC Oxford (02-01-2023 to 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 20555.72 }, { "payer_name": "UHC - Adhoc", "plan_name": "UHC - Adhoc All Payer", "methodology": "case rate", "standard_charge_dollar": 25037.67 }, { "payer_name": "UHC - Adhoc", "plan_name": "UHC - Adhoc Oxford", "methodology": "case rate", "standard_charge_dollar": 21182.6 }, { "payer_name": "Wellcare", "plan_name": "Wellcare Insurance Exchange", "methodology": "case rate", "standard_charge_dollar": 23932.38, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "case rate", "standard_charge_dollar": 14541.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup Medicare", "methodology": "case rate", "standard_charge_dollar": 14541.6, "additional_payer_notes": "100.00% of Medicare Rates" } ] } ] }, { "description": "COMPLICATIONS OF TREATMENT WITHOUT CCMCC", "code_information": [ { "code": "921", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 9512.0, "minimum": 4412.25, "maximum": 17217.0639, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "case rate", "standard_charge_dollar": 17217.06, "additional_payer_notes": "181.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medical Rental Network", "methodology": "case rate", "standard_charge_dollar": 17217.06, "additional_payer_notes": "181.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "case rate", "standard_charge_dollar": 7944.75, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "ALLY-ALIGN (FKA SPARTAN PLAN NJ, INC.)", "plan_name": "ALLY-ALIGN (FKA SPARTAN PLAN NJ, INC.)", "methodology": "case rate", "standard_charge_dollar": 9987.8, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Americhoice (UHC)", "plan_name": "UHC Medicare", "methodology": "case rate", "standard_charge_dollar": 7944.75, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Amerihealth", "plan_name": "Amerihealth Medicare", "methodology": "case rate", "standard_charge_dollar": 7944.75, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Commercial", "methodology": "case rate", "standard_charge_dollar": 10071.29 }, { "payer_name": "Clover Health", "plan_name": "Clover Medicare", "methodology": "case rate", "standard_charge_dollar": 7944.75, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Coventry", "plan_name": "Coventry Auto", "methodology": "case rate", "standard_charge_dollar": 16170.72, "additional_payer_notes": "170.00% of Medicare Rates" }, { "payer_name": "Coventry", "plan_name": "Coventry Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 16170.72, "additional_payer_notes": "170.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "case rate", "standard_charge_dollar": 12365.85, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Fairprice Healthcare Holdings", "plan_name": "Fairprice Healthcare Holdings", "methodology": "case rate", "standard_charge_dollar": 15219.5, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon Medicare", "methodology": "case rate", "standard_charge_dollar": 7944.75, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon NJ Health Medicaid", "methodology": "case rate", "standard_charge_dollar": 4412.25 }, { "payer_name": "Humana", "plan_name": "Humana Military Tricare", "methodology": "case rate", "standard_charge_dollar": 7609.75, "additional_payer_notes": "80.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 9512.19, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 7878.68 }, { "payer_name": "UBH", "plan_name": "UBH Medicare", "methodology": "case rate", "standard_charge_dollar": 7944.75, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC All Payer (02-01-2023 to 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 11603.67 }, { "payer_name": "UHC", "plan_name": "UHC Oxford (02-01-2023 to 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 10112.6 }, { "payer_name": "UHC - Adhoc", "plan_name": "UHC - Adhoc All Payer", "methodology": "case rate", "standard_charge_dollar": 12317.54 }, { "payer_name": "UHC - Adhoc", "plan_name": "UHC - Adhoc Oxford", "methodology": "case rate", "standard_charge_dollar": 10421.0 }, { "payer_name": "Wellcare", "plan_name": "Wellcare Insurance Exchange", "methodology": "case rate", "standard_charge_dollar": 12841.46, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "case rate", "standard_charge_dollar": 7944.75, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup Medicare", "methodology": "case rate", "standard_charge_dollar": 7944.75, "additional_payer_notes": "100.00% of Medicare Rates" } ] } ] }, { "description": "Hc Remv Vein Clot Cava-Iliac,Abd Incis", "code_information": [ { "code": "34401", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 1557.65, "minimum": 297.3554, "maximum": 1557.65, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1546.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC All Payer (02-01-2023 to 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 1557.65 }, { "payer_name": "UHC", "plan_name": "UHC Oxford (02-01-2023 to 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 1557.65 }, { "payer_name": "UHC - Adhoc", "plan_name": "UHC - Adhoc All Payer", "methodology": "case rate", "standard_charge_dollar": 1557.65 }, { "payer_name": "UHC - Adhoc", "plan_name": "UHC - Adhoc Oxford", "methodology": "case rate", "standard_charge_dollar": 1557.65 }, { "payer_name": "Wellchoice", "plan_name": "WELLCHOICE HMO of NJ (Empire) Commercial (HMO / HMO POS, PPO)", "methodology": "case rate", "standard_charge_dollar": 1557.65 }, { "payer_name": "Wellchoice", "plan_name": "WELLCHOICE HMO of NJ (Empire) Commercial (Indemnity)", "methodology": "case rate", "standard_charge_dollar": 1557.65 } ] } ] }, { "description": "CIRRHOSIS AND ALCOHOLIC HEPATITIS WITH CC", "code_information": [ { "code": "433", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 13762.0, "minimum": 6418.55, "maximum": 24910.4146, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "case rate", "standard_charge_dollar": 24910.41, "additional_payer_notes": "181.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medical Rental Network", "methodology": "case rate", "standard_charge_dollar": 24910.41, "additional_payer_notes": "181.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "case rate", "standard_charge_dollar": 11357.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "ALLY-ALIGN (FKA SPARTAN PLAN NJ, INC.)", "plan_name": "ALLY-ALIGN (FKA SPARTAN PLAN NJ, INC.)", "methodology": "case rate", "standard_charge_dollar": 14450.79, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Americhoice (UHC)", "plan_name": "UHC Medicare", "methodology": "case rate", "standard_charge_dollar": 11357.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Amerihealth", "plan_name": "Amerihealth Medicare", "methodology": "case rate", "standard_charge_dollar": 11357.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Commercial", "methodology": "case rate", "standard_charge_dollar": 15452.21 }, { "payer_name": "Clover Health", "plan_name": "Clover Medicare", "methodology": "case rate", "standard_charge_dollar": 11357.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Coventry", "plan_name": "Coventry Auto", "methodology": "case rate", "standard_charge_dollar": 23396.52, "additional_payer_notes": "170.00% of Medicare Rates" }, { "payer_name": "Coventry", "plan_name": "Coventry Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 23396.52, "additional_payer_notes": "170.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "case rate", "standard_charge_dollar": 17891.46, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Fairprice Healthcare Holdings", "plan_name": "Fairprice Healthcare Holdings", "methodology": "case rate", "standard_charge_dollar": 22020.26, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon Medicare", "methodology": "case rate", "standard_charge_dollar": 11357.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon NJ Health Medicaid", "methodology": "case rate", "standard_charge_dollar": 6418.55 }, { "payer_name": "Humana", "plan_name": "Humana Military Tricare", "methodology": "case rate", "standard_charge_dollar": 11010.13, "additional_payer_notes": "80.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 13762.66, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 13229.0 }, { "payer_name": "UBH", "plan_name": "UBH Medicare", "methodology": "case rate", "standard_charge_dollar": 11357.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC All Payer (02-01-2023 to 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 17803.31 }, { "payer_name": "UHC", "plan_name": "UHC Oxford (02-01-2023 to 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 15515.58 }, { "payer_name": "UHC - Adhoc", "plan_name": "UHC - Adhoc All Payer", "methodology": "case rate", "standard_charge_dollar": 18898.59 }, { "payer_name": "UHC - Adhoc", "plan_name": "UHC - Adhoc Oxford", "methodology": "case rate", "standard_charge_dollar": 15988.76 }, { "payer_name": "Wellcare", "plan_name": "Wellcare Insurance Exchange", "methodology": "case rate", "standard_charge_dollar": 18579.59, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "case rate", "standard_charge_dollar": 11357.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup Medicare", "methodology": "case rate", "standard_charge_dollar": 11357.8, "additional_payer_notes": "100.00% of Medicare Rates" } ] } ] }, { "description": "Hc Rplc Cv Cath Cmplt Tunld Wo Subq Port/Pump", "code_information": [ { "code": "36581", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 340.0, "discounted_cash": 3732.0, "minimum": 64.906, "maximum": 340.0, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 340.0, "additional_payer_notes": "212.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medical Rental Network", "methodology": "fee schedule", "standard_charge_dollar": 340.0, "additional_payer_notes": "212.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 340.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "ALLY-ALIGN (FKA SPARTAN PLAN NJ, INC.)", "plan_name": "ALLY-ALIGN (FKA SPARTAN PLAN NJ, INC.)", "methodology": "fee schedule", "standard_charge_dollar": 340.0, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Americhoice (UHC)", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 340.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Amerihealth", "plan_name": "Amerihealth Medicare", "methodology": "fee schedule", "standard_charge_dollar": 340.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 340.0, "additional_payer_notes": "146.95% of Medicare Rates" }, { "payer_name": "Clover Health", "plan_name": "Clover Medicare", "methodology": "fee schedule", "standard_charge_dollar": 340.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Coventry", "plan_name": "Coventry Auto", "methodology": "fee schedule", "standard_charge_dollar": 340.0, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Coventry", "plan_name": "Coventry Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 340.0, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "fee schedule", "standard_charge_dollar": 340.0, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Fairprice Healthcare Holdings", "plan_name": "Fairprice Healthcare Holdings", "methodology": "fee schedule", "standard_charge_dollar": 340.0, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ HMO POS", "methodology": "fee schedule", "standard_charge_dollar": 340.0, "additional_payer_notes": "177.30% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ Indemnity", "methodology": "fee schedule", "standard_charge_dollar": 340.0, "additional_payer_notes": "177.30% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ PPO", "methodology": "fee schedule", "standard_charge_dollar": 340.0, "additional_payer_notes": "177.30% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon Medicare", "methodology": "fee schedule", "standard_charge_dollar": 340.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Military Tricare", "methodology": "fee schedule", "standard_charge_dollar": 340.0, "additional_payer_notes": "80.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 340.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 340.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC All Payer (02-01-2023 to 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 340.0 }, { "payer_name": "UHC", "plan_name": "UHC Oxford (02-01-2023 to 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 340.0 }, { "payer_name": "UHC - Adhoc", "plan_name": "UHC - Adhoc All Payer", "methodology": "case rate", "standard_charge_dollar": 340.0 }, { "payer_name": "UHC - Adhoc", "plan_name": "UHC - Adhoc Oxford", "methodology": "case rate", "standard_charge_dollar": 340.0 }, { "payer_name": "Wellcare", "plan_name": "Wellcare Insurance Exchange", "methodology": "fee schedule", "standard_charge_dollar": 340.0, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 340.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellchoice", "plan_name": "WELLCHOICE HMO of NJ (Empire) Commercial (HMO / HMO POS, PPO)", "methodology": "case rate", "standard_charge_dollar": 340.0 }, { "payer_name": "Wellchoice", "plan_name": "WELLCHOICE HMO of NJ (Empire) Commercial (Indemnity)", "methodology": "case rate", "standard_charge_dollar": 340.0 }, { "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup Medicare", "methodology": "fee schedule", "standard_charge_dollar": 340.0, "additional_payer_notes": "100.00% of Medicare Rates" } ] } ] }, { "description": "Hc Rmvl Prm Epicar Pm&Eltrds Thorcom Dual Lead Sy", "code_information": [ { "code": "33237", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 1800.0, "minimum": 343.62, "maximum": 1800.0, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 906.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC All Payer (02-01-2023 to 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 1800.0 }, { "payer_name": "UHC", "plan_name": "UHC Oxford (02-01-2023 to 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 1800.0 }, { "payer_name": "UHC - Adhoc", "plan_name": "UHC - Adhoc All Payer", "methodology": "case rate", "standard_charge_dollar": 1800.0 }, { "payer_name": "UHC - Adhoc", "plan_name": "UHC - Adhoc Oxford", "methodology": "case rate", "standard_charge_dollar": 1800.0 }, { "payer_name": "Wellchoice", "plan_name": "WELLCHOICE HMO of NJ (Empire) Commercial (HMO / HMO POS, PPO)", "methodology": "case rate", "standard_charge_dollar": 1715.0 }, { "payer_name": "Wellchoice", "plan_name": "WELLCHOICE HMO of NJ (Empire) Commercial (Indemnity)", "methodology": "case rate", "standard_charge_dollar": 1800.0 } ] } ] }, { "description": "Hc Assay Of Iron", "code_information": [ { "code": "83540", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 64.0, "discounted_cash": 6.0, "minimum": 3.88, "maximum": 54.4, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 13.72, "additional_payer_notes": "212.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medical Rental Network", "methodology": "fee schedule", "standard_charge_dollar": 13.72, "additional_payer_notes": "212.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 6.47, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "ALLY-ALIGN (FKA SPARTAN PLAN NJ, INC.)", "plan_name": "ALLY-ALIGN (FKA SPARTAN PLAN NJ, INC.)", "methodology": "fee schedule", "standard_charge_dollar": 6.79, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Americhoice (UHC)", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 6.47, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Amerihealth", "plan_name": "Amerihealth Medicare", "methodology": "fee schedule", "standard_charge_dollar": 6.47, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 9.38, "additional_payer_notes": "Laboratory - 145.00% of Medicare Rates" }, { "payer_name": "Clover Health", "plan_name": "Clover Medicare", "methodology": "fee schedule", "standard_charge_dollar": 6.47, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Coventry", "plan_name": "Coventry Auto", "methodology": "fee schedule", "standard_charge_dollar": 12.94, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Coventry", "plan_name": "Coventry Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 12.94, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "fee schedule", "standard_charge_dollar": 9.06, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Fairprice Healthcare Holdings", "plan_name": "Fairprice Healthcare Holdings", "methodology": "fee schedule", "standard_charge_dollar": 7.76, "additional_payer_notes": "Laboratory - 120.00% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ HMO POS", "methodology": "fee schedule", "standard_charge_dollar": 45.18, "additional_payer_notes": "177.30% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ Indemnity", "methodology": "fee schedule", "standard_charge_dollar": 45.18, "additional_payer_notes": "177.30% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ PPO", "methodology": "fee schedule", "standard_charge_dollar": 45.18, "additional_payer_notes": "177.30% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon Medicare", "methodology": "fee schedule", "standard_charge_dollar": 6.47, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Military Tricare", "methodology": "fee schedule", "standard_charge_dollar": 5.18, "additional_payer_notes": "80.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 6.47, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 6.47, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC All Payer (02-01-2023 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 3.88 }, { "payer_name": "UHC", "plan_name": "UHC Medicaid (02/01/2023 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 5.18 }, { "payer_name": "UHC", "plan_name": "UHC Oxford (02-01-2023 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 3.88 }, { "payer_name": "UHC - Adhoc", "plan_name": "UHC - Adhoc All Payer", "methodology": "fee schedule", "standard_charge_dollar": 6.47 }, { "payer_name": "UHC - Adhoc", "plan_name": "UHC - Adhoc Oxford", "methodology": "fee schedule", "standard_charge_dollar": 6.47 }, { "payer_name": "Wellcare", "plan_name": "Wellcare Insurance Exchange", "methodology": "fee schedule", "standard_charge_dollar": 8.73, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 6.47, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup Medicaid", "methodology": "percent of total billed charges", "standard_charge_percentage": 19.09, "median_amount": 11.94, "10th_percentile": 6.47, "90th_percentile": 11.94, "count": "1 through 10" }, { "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup Medicare", "methodology": "fee schedule", "standard_charge_dollar": 6.47, "additional_payer_notes": "100.00% of Medicare Rates" } ] } ] }, { "description": "Hc Ct Scan,Head/Brain,W/O Contrast Matl", "code_information": [ { "code": "70450", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 2219.0, "discounted_cash": 123.0, "minimum": 98.872, "maximum": 1886.15, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 262.01, "additional_payer_notes": "212.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medical Rental Network", "methodology": "fee schedule", "standard_charge_dollar": 262.01, "additional_payer_notes": "212.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 123.59, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "ALLY-ALIGN (FKA SPARTAN PLAN NJ, INC.)", "plan_name": "ALLY-ALIGN (FKA SPARTAN PLAN NJ, INC.)", "methodology": "fee schedule", "standard_charge_dollar": 129.77, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Americhoice (UHC)", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 123.59, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Amerihealth", "plan_name": "Amerihealth HMO", "methodology": "fee schedule", "standard_charge_dollar": 356.25 }, { "payer_name": "Amerihealth", "plan_name": "Amerihealth Medicare", "methodology": "fee schedule", "standard_charge_dollar": 123.59, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 181.62, "additional_payer_notes": "146.95% of Medicare Rates" }, { "payer_name": "Clover Health", "plan_name": "Clover Medicare", "methodology": "fee schedule", "standard_charge_dollar": 123.59, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Coventry", "plan_name": "Coventry Auto", "methodology": "fee schedule", "standard_charge_dollar": 247.18, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Coventry", "plan_name": "Coventry Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 247.18, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "fee schedule", "standard_charge_dollar": 173.03, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Fairprice Healthcare Holdings", "plan_name": "Fairprice Healthcare Holdings", "methodology": "fee schedule", "standard_charge_dollar": 197.74, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ HMO POS", "methodology": "fee schedule", "standard_charge_dollar": 219.13, "additional_payer_notes": "177.30% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ Indemnity", "methodology": "fee schedule", "standard_charge_dollar": 219.13, "additional_payer_notes": "177.30% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ PPO", "methodology": "fee schedule", "standard_charge_dollar": 219.13, "additional_payer_notes": "177.30% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon Casualty Services Workers Compensation", "methodology": "percent of total billed charges", "standard_charge_percentage": 78.4, "median_amount": 215.52, "10th_percentile": 215.52, "90th_percentile": 215.52, "count": "1 through 10" }, { "payer_name": "Horizon", "plan_name": "Horizon Medicare", "methodology": "fee schedule", "standard_charge_dollar": 123.59, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon NJ Health Medicaid", "methodology": "percent of total billed charges", "standard_charge_percentage": 19.58, "median_amount": 434.48, "10th_percentile": 434.48, "90th_percentile": 434.48, "count": "217" }, { "payer_name": "Humana", "plan_name": "Humana Military Tricare", "methodology": "fee schedule", "standard_charge_dollar": 98.87, "additional_payer_notes": "80.00% of Medicare Rates" }, { "payer_name": "Keenan", "plan_name": "Keenan", "methodology": "percent of total billed charges", "standard_charge_percentage": 30.0, "median_amount": 665.7, "10th_percentile": 665.7, "90th_percentile": 1492.77, "count": "1 through 10" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 123.59, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 123.59, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC All Payer (02-01-2023 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 163.46 }, { "payer_name": "UHC", "plan_name": "UHC Medicaid (02/01/2023 to 12-31-2026)", "methodology": "percent of total billed charges", "standard_charge_percentage": 19.47, "median_amount": 422.12, "10th_percentile": 125.23, "90th_percentile": 432.08, "count": "59" }, { "payer_name": "UHC", "plan_name": "UHC Oxford (02-01-2023 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 163.46 }, { "payer_name": "UHC - Adhoc", "plan_name": "UHC - Adhoc All Payer", "methodology": "fee schedule", "standard_charge_dollar": 108.97 }, { "payer_name": "UHC - Adhoc", "plan_name": "UHC - Adhoc Oxford", "methodology": "fee schedule", "standard_charge_dollar": 108.97 }, { "payer_name": "Wellcare", "plan_name": "Wellcare Insurance Exchange", "methodology": "fee schedule", "standard_charge_dollar": 166.85, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 123.59, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup Medicaid", "methodology": "percent of total billed charges", "standard_charge_percentage": 19.09, "median_amount": 413.84, "10th_percentile": 206.92, "90th_percentile": 413.84, "count": "52" }, { "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup Medicare", "methodology": "fee schedule", "standard_charge_dollar": 123.59, "additional_payer_notes": "100.00% of Medicare Rates" } ] } ] }, { "description": "BILATERAL OR MULTIPLE MAJOR JOINT PROCEDURES OF LOWER EXTREMITY WITHOUT MCC", "code_information": [ { "code": "462", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 32296.0, "minimum": 19945.03, "maximum": 62007.0633, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "case rate", "standard_charge_dollar": 58457.44, "additional_payer_notes": "181.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medical Rental Network", "methodology": "case rate", "standard_charge_dollar": 58457.44, "additional_payer_notes": "181.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "case rate", "standard_charge_dollar": 26240.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "ALLY-ALIGN (FKA SPARTAN PLAN NJ, INC.)", "plan_name": "ALLY-ALIGN (FKA SPARTAN PLAN NJ, INC.)", "methodology": "case rate", "standard_charge_dollar": 33911.78, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Americhoice (UHC)", "plan_name": "UHC Medicare", "methodology": "case rate", "standard_charge_dollar": 26240.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Amerihealth", "plan_name": "Amerihealth Medicare", "methodology": "case rate", "standard_charge_dollar": 26240.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Commercial", "methodology": "case rate", "standard_charge_dollar": 38915.8 }, { "payer_name": "Clover Health", "plan_name": "Clover Medicare", "methodology": "case rate", "standard_charge_dollar": 26240.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Coventry", "plan_name": "Coventry Auto", "methodology": "case rate", "standard_charge_dollar": 54904.78, "additional_payer_notes": "170.00% of Medicare Rates" }, { "payer_name": "Coventry", "plan_name": "Coventry Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 54904.78, "additional_payer_notes": "170.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "case rate", "standard_charge_dollar": 41986.01, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Fairprice Healthcare Holdings", "plan_name": "Fairprice Healthcare Holdings", "methodology": "case rate", "standard_charge_dollar": 51675.09, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon Medicare", "methodology": "case rate", "standard_charge_dollar": 26240.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon NJ Health Medicaid", "methodology": "case rate", "standard_charge_dollar": 19945.03 }, { "payer_name": "Humana", "plan_name": "Humana Military Tricare", "methodology": "case rate", "standard_charge_dollar": 25837.54, "additional_payer_notes": "80.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 32296.93, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 31146.4 }, { "payer_name": "UBH", "plan_name": "UBH Medicare", "methodology": "case rate", "standard_charge_dollar": 26240.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC All Payer (02-01-2023 to 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 44836.96 }, { "payer_name": "UHC", "plan_name": "UHC Oxford (02-01-2023 to 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 39075.4 }, { "payer_name": "UHC - Adhoc", "plan_name": "UHC - Adhoc All Payer", "methodology": "case rate", "standard_charge_dollar": 47595.38 }, { "payer_name": "UHC - Adhoc", "plan_name": "UHC - Adhoc Oxford", "methodology": "case rate", "standard_charge_dollar": 40267.08 }, { "payer_name": "Wellcare", "plan_name": "Wellcare Insurance Exchange", "methodology": "case rate", "standard_charge_dollar": 43600.86, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "case rate", "standard_charge_dollar": 26240.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup Medicare", "methodology": "case rate", "standard_charge_dollar": 26240.3, "additional_payer_notes": "100.00% of Medicare Rates" } ] } ] }, { "description": "Hc Mri Abdomen W Contrast", "code_information": [ { "code": "74182", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 3621.0, "discounted_cash": 412.0, "minimum": 329.952, "maximum": 3077.85, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 874.37, "additional_payer_notes": "212.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medical Rental Network", "methodology": "fee schedule", "standard_charge_dollar": 874.37, "additional_payer_notes": "212.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 412.44, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "ALLY-ALIGN (FKA SPARTAN PLAN NJ, INC.)", "plan_name": "ALLY-ALIGN (FKA SPARTAN PLAN NJ, INC.)", "methodology": "fee schedule", "standard_charge_dollar": 433.06, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Americhoice (UHC)", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 412.44, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Amerihealth", "plan_name": "Amerihealth HMO", "methodology": "fee schedule", "standard_charge_dollar": 886.6 }, { "payer_name": "Amerihealth", "plan_name": "Amerihealth Medicare", "methodology": "fee schedule", "standard_charge_dollar": 412.44, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 606.08, "additional_payer_notes": "146.95% of Medicare Rates" }, { "payer_name": "Clover Health", "plan_name": "Clover Medicare", "methodology": "fee schedule", "standard_charge_dollar": 412.44, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Coventry", "plan_name": "Coventry Auto", "methodology": "fee schedule", "standard_charge_dollar": 824.88, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Coventry", "plan_name": "Coventry Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 824.88, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "fee schedule", "standard_charge_dollar": 577.42, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Fairprice Healthcare Holdings", "plan_name": "Fairprice Healthcare Holdings", "methodology": "fee schedule", "standard_charge_dollar": 659.9, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ HMO POS", "methodology": "fee schedule", "standard_charge_dollar": 731.26, "additional_payer_notes": "177.30% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ Indemnity", "methodology": "fee schedule", "standard_charge_dollar": 731.26, "additional_payer_notes": "177.30% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ PPO", "methodology": "fee schedule", "standard_charge_dollar": 731.26, "additional_payer_notes": "177.30% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon Medicare", "methodology": "fee schedule", "standard_charge_dollar": 412.44, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Military Tricare", "methodology": "fee schedule", "standard_charge_dollar": 329.95, "additional_payer_notes": "80.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 412.44, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 412.44, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC All Payer (02-01-2023 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 552.18 }, { "payer_name": "UHC", "plan_name": "UHC Oxford (02-01-2023 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 552.18 }, { "payer_name": "UHC - Adhoc", "plan_name": "UHC - Adhoc All Payer", "methodology": "fee schedule", "standard_charge_dollar": 368.12 }, { "payer_name": "UHC - Adhoc", "plan_name": "UHC - Adhoc Oxford", "methodology": "fee schedule", "standard_charge_dollar": 368.12 }, { "payer_name": "Wellcare", "plan_name": "Wellcare Insurance Exchange", "methodology": "fee schedule", "standard_charge_dollar": 556.79, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 412.44, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup Medicare", "methodology": "fee schedule", "standard_charge_dollar": 412.44, "additional_payer_notes": "100.00% of Medicare Rates" } ] } ] }, { "description": "CORONARY BYPASS WITHOUT CARDIAC CATHETERIZATION WITHOUT MCC", "code_information": [ { "code": "236", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 49964.0, "minimum": 24517.13, "maximum": 90435.6726, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "case rate", "standard_charge_dollar": 90435.67, "additional_payer_notes": "181.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medical Rental Network", "methodology": "case rate", "standard_charge_dollar": 90435.67, "additional_payer_notes": "181.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "case rate", "standard_charge_dollar": 40426.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "ALLY-ALIGN (FKA SPARTAN PLAN NJ, INC.)", "plan_name": "ALLY-ALIGN (FKA SPARTAN PLAN NJ, INC.)", "methodology": "case rate", "standard_charge_dollar": 52462.68, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Americhoice (UHC)", "plan_name": "UHC Medicare", "methodology": "case rate", "standard_charge_dollar": 40426.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Amerihealth", "plan_name": "Amerihealth Medicare", "methodology": "case rate", "standard_charge_dollar": 40426.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Commercial", "methodology": "case rate", "standard_charge_dollar": 61282.14 }, { "payer_name": "Clover Health", "plan_name": "Clover Medicare", "methodology": "case rate", "standard_charge_dollar": 40426.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Coventry", "plan_name": "Coventry Auto", "methodology": "case rate", "standard_charge_dollar": 84939.58, "additional_payer_notes": "170.00% of Medicare Rates" }, { "payer_name": "Coventry", "plan_name": "Coventry Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 84939.58, "additional_payer_notes": "170.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "case rate", "standard_charge_dollar": 64953.8, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Fairprice Healthcare Holdings", "plan_name": "Fairprice Healthcare Holdings", "methodology": "case rate", "standard_charge_dollar": 79943.14, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon Medicare", "methodology": "case rate", "standard_charge_dollar": 40426.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon NJ Health Medicaid", "methodology": "case rate", "standard_charge_dollar": 24517.13 }, { "payer_name": "Humana", "plan_name": "Humana Military Tricare", "methodology": "case rate", "standard_charge_dollar": 39971.57, "additional_payer_notes": "80.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 49964.46, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 64062.3 }, { "payer_name": "UBH", "plan_name": "UBH Medicare", "methodology": "case rate", "standard_charge_dollar": 40426.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC All Payer (02-01-2023 to 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 70606.41 }, { "payer_name": "UHC", "plan_name": "UHC Oxford (02-01-2023 to 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 61533.47 }, { "payer_name": "UHC - Adhoc", "plan_name": "UHC - Adhoc All Payer", "methodology": "case rate", "standard_charge_dollar": 74950.2 }, { "payer_name": "UHC - Adhoc", "plan_name": "UHC - Adhoc Oxford", "methodology": "case rate", "standard_charge_dollar": 63410.05 }, { "payer_name": "Wellcare", "plan_name": "Wellcare Insurance Exchange", "methodology": "case rate", "standard_charge_dollar": 67452.02, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "case rate", "standard_charge_dollar": 40426.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup Medicare", "methodology": "case rate", "standard_charge_dollar": 40426.8, "additional_payer_notes": "100.00% of Medicare Rates" } ] } ] }, { "description": "MAJOR HEMATOLOGICIMMUNOLOGIC DIAG EXC SICKLE CELL CRISIS & COAGUL - SOI : 3", "code_information": [ { "code": "6603", "type": "APR-DRG" } ], "standard_charges": [ { "setting": "inpatient", "minimum": 13819.72, "maximum": 15201.7, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Better Health - Medi Medi", "methodology": "case rate", "standard_charge_dollar": 15201.7, "additional_payer_notes": "110% of State Medicaid Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Better Health Medicaid", "methodology": "case rate", "standard_charge_dollar": 15201.7, "additional_payer_notes": "110% of State Medicaid Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "case rate", "standard_charge_dollar": 13819.72, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "UBH", "plan_name": "UBH Medicaid", "methodology": "case rate", "standard_charge_dollar": 13819.72, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicaid (02/01/2023 to 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 14096.12, "additional_payer_notes": "102% of State Medicaid Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicaid", "methodology": "case rate", "standard_charge_dollar": 13819.72, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup Medicaid", "methodology": "case rate", "standard_charge_dollar": 13819.72, "additional_payer_notes": "100% of State Medicaid Rates" } ] } ] }, { "description": "Hc Pap By Tech, Screening", "code_information": [ { "code": "P3000", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 63.0, "discounted_cash": 18.0, "minimum": 8.88, "maximum": 53.55, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 39.3, "additional_payer_notes": "212.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medical Rental Network", "methodology": "fee schedule", "standard_charge_dollar": 39.3, "additional_payer_notes": "212.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 18.54, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "ALLY-ALIGN (FKA SPARTAN PLAN NJ, INC.)", "plan_name": "ALLY-ALIGN (FKA SPARTAN PLAN NJ, INC.)", "methodology": "fee schedule", "standard_charge_dollar": 19.47, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Americhoice (UHC)", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 18.54, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Amerihealth", "plan_name": "Amerihealth Medicare", "methodology": "fee schedule", "standard_charge_dollar": 18.54, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 26.88, "additional_payer_notes": "A Indicator - 155.00% of Medicare Rates" }, { "payer_name": "Clover Health", "plan_name": "Clover Medicare", "methodology": "fee schedule", "standard_charge_dollar": 18.54, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Coventry", "plan_name": "Coventry Auto", "methodology": "fee schedule", "standard_charge_dollar": 37.08, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Coventry", "plan_name": "Coventry Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 37.08, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "fee schedule", "standard_charge_dollar": 25.96, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Fairprice Healthcare Holdings", "plan_name": "Fairprice Healthcare Holdings", "methodology": "fee schedule", "standard_charge_dollar": 22.25, "additional_payer_notes": "Laboratory - 120.00% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ HMO POS", "methodology": "fee schedule", "standard_charge_dollar": 44.48, "additional_payer_notes": "177.30% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ Indemnity", "methodology": "fee schedule", "standard_charge_dollar": 44.48, "additional_payer_notes": "177.30% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ PPO", "methodology": "fee schedule", "standard_charge_dollar": 44.48, "additional_payer_notes": "177.30% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon Medicare", "methodology": "fee schedule", "standard_charge_dollar": 18.54, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon NJ Health Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 8.88 }, { "payer_name": "Humana", "plan_name": "Humana Military Tricare", "methodology": "fee schedule", "standard_charge_dollar": 14.83, "additional_payer_notes": "80.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 18.54, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 18.54, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC All Payer (02-01-2023 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 9.07 }, { "payer_name": "UHC", "plan_name": "UHC Medicaid (02/01/2023 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 8.88 }, { "payer_name": "UHC", "plan_name": "UHC Oxford (02-01-2023 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 9.07 }, { "payer_name": "UHC - Adhoc", "plan_name": "UHC - Adhoc All Payer", "methodology": "fee schedule", "standard_charge_dollar": 15.12 }, { "payer_name": "UHC - Adhoc", "plan_name": "UHC - Adhoc Oxford", "methodology": "fee schedule", "standard_charge_dollar": 15.12 }, { "payer_name": "Wellcare", "plan_name": "Wellcare Insurance Exchange", "methodology": "fee schedule", "standard_charge_dollar": 25.03, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 18.54, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup Medicare", "methodology": "fee schedule", "standard_charge_dollar": 18.54, "additional_payer_notes": "100.00% of Medicare Rates" } ] } ] }, { "description": "Treatment Of Tibia Fracture", "code_information": [ { "code": "27759", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 58428.0, "discounted_cash": 15177.0, "minimum": 1715.0, "maximum": 46742.4, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 32177.25, "additional_payer_notes": "212.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medical Rental Network", "methodology": "fee schedule", "standard_charge_dollar": 32177.25, "additional_payer_notes": "212.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 15177.95, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "ALLY-ALIGN (FKA SPARTAN PLAN NJ, INC.)", "plan_name": "ALLY-ALIGN (FKA SPARTAN PLAN NJ, INC.)", "methodology": "fee schedule", "standard_charge_dollar": 15936.85, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Americhoice (UHC)", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 15177.95, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Amerihealth", "plan_name": "Amerihealth Medicare", "methodology": "fee schedule", "standard_charge_dollar": 15177.95, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 22304.0, "additional_payer_notes": "146.95% of Medicare Rates" }, { "payer_name": "Clover Health", "plan_name": "Clover Medicare", "methodology": "fee schedule", "standard_charge_dollar": 15177.95, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Coventry", "plan_name": "Coventry Auto", "methodology": "fee schedule", "standard_charge_dollar": 30355.9, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Coventry", "plan_name": "Coventry Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 30355.9, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "fee schedule", "standard_charge_dollar": 21249.13, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Fairprice Healthcare Holdings", "plan_name": "Fairprice Healthcare Holdings", "methodology": "fee schedule", "standard_charge_dollar": 24284.72, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ HMO POS", "methodology": "fee schedule", "standard_charge_dollar": 26910.51, "additional_payer_notes": "177.30% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ Indemnity", "methodology": "fee schedule", "standard_charge_dollar": 26910.51, "additional_payer_notes": "177.30% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ PPO", "methodology": "fee schedule", "standard_charge_dollar": 26910.51, "additional_payer_notes": "177.30% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon Medicare", "methodology": "fee schedule", "standard_charge_dollar": 15177.95, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Military Tricare", "methodology": "fee schedule", "standard_charge_dollar": 12142.36, "additional_payer_notes": "80.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 15177.95, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 15177.95, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC All Payer (02-01-2023 to 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 6624.0 }, { "payer_name": "UHC", "plan_name": "UHC Oxford (02-01-2023 to 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 6317.0 }, { "payer_name": "UHC - Adhoc", "plan_name": "UHC - Adhoc All Payer", "methodology": "case rate", "standard_charge_dollar": 7031.0 }, { "payer_name": "UHC - Adhoc", "plan_name": "UHC - Adhoc Oxford", "methodology": "case rate", "standard_charge_dollar": 6510.0 }, { "payer_name": "Wellcare", "plan_name": "Wellcare Insurance Exchange", "methodology": "fee schedule", "standard_charge_dollar": 20490.23, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 15177.95, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellchoice", "plan_name": "WELLCHOICE HMO of NJ (Empire) Commercial (HMO / HMO POS, PPO)", "methodology": "case rate", "standard_charge_dollar": 1715.0 }, { "payer_name": "Wellchoice", "plan_name": "WELLCHOICE HMO of NJ (Empire) Commercial (Indemnity)", "methodology": "case rate", "standard_charge_dollar": 1978.0 }, { "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup Medicare", "methodology": "fee schedule", "standard_charge_dollar": 15177.95, "additional_payer_notes": "100.00% of Medicare Rates" } ] } ] }, { "description": "OTHER KIDNEY AND URINARY TRACT DIAGNOSES WITH CC", "code_information": [ { "code": "699", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 13286.0, "minimum": 6418.55, "maximum": 24048.6374, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "case rate", "standard_charge_dollar": 24048.64, "additional_payer_notes": "181.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medical Rental Network", "methodology": "case rate", "standard_charge_dollar": 24048.64, "additional_payer_notes": "181.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "case rate", "standard_charge_dollar": 10975.4, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "ALLY-ALIGN (FKA SPARTAN PLAN NJ, INC.)", "plan_name": "ALLY-ALIGN (FKA SPARTAN PLAN NJ, INC.)", "methodology": "case rate", "standard_charge_dollar": 13950.87, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Americhoice (UHC)", "plan_name": "UHC Medicare", "methodology": "case rate", "standard_charge_dollar": 10975.4, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Amerihealth", "plan_name": "Amerihealth Medicare", "methodology": "case rate", "standard_charge_dollar": 10975.4, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Commercial", "methodology": "case rate", "standard_charge_dollar": 14849.45 }, { "payer_name": "Clover Health", "plan_name": "Clover Medicare", "methodology": "case rate", "standard_charge_dollar": 10975.4, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Coventry", "plan_name": "Coventry Auto", "methodology": "case rate", "standard_charge_dollar": 22587.12, "additional_payer_notes": "170.00% of Medicare Rates" }, { "payer_name": "Coventry", "plan_name": "Coventry Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 22587.12, "additional_payer_notes": "170.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "case rate", "standard_charge_dollar": 17272.5, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Fairprice Healthcare Holdings", "plan_name": "Fairprice Healthcare Holdings", "methodology": "case rate", "standard_charge_dollar": 21258.46, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon Medicare", "methodology": "case rate", "standard_charge_dollar": 10975.4, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon NJ Health Medicaid", "methodology": "case rate", "standard_charge_dollar": 6418.55 }, { "payer_name": "Humana", "plan_name": "Humana Military Tricare", "methodology": "case rate", "standard_charge_dollar": 10629.23, "additional_payer_notes": "80.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 13286.54, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 11369.1 }, { "payer_name": "UBH", "plan_name": "UBH Medicare", "methodology": "case rate", "standard_charge_dollar": 10975.4, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC All Payer (02-01-2023 to 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 17108.84 }, { "payer_name": "UHC", "plan_name": "UHC Oxford (02-01-2023 to 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 14910.35 }, { "payer_name": "UHC - Adhoc", "plan_name": "UHC - Adhoc All Payer", "methodology": "case rate", "standard_charge_dollar": 18161.4 }, { "payer_name": "UHC - Adhoc", "plan_name": "UHC - Adhoc Oxford", "methodology": "case rate", "standard_charge_dollar": 15365.07 }, { "payer_name": "Wellcare", "plan_name": "Wellcare Insurance Exchange", "methodology": "case rate", "standard_charge_dollar": 17936.83, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "case rate", "standard_charge_dollar": 10975.4, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup Medicare", "methodology": "case rate", "standard_charge_dollar": 10975.4, "additional_payer_notes": "100.00% of Medicare Rates" } ] } ] }, { "description": "MAJOR O.R. PROCEDURES FOR LYMPHATICHEMATOPOIETICOTHER NEOPLASMS - SOI : 4", "code_information": [ { "code": "6804", "type": "APR-DRG" } ], "standard_charges": [ { "setting": "inpatient", "minimum": 81696.11, "maximum": 89865.72, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Better Health - Medi Medi", "methodology": "case rate", "standard_charge_dollar": 89865.72, "additional_payer_notes": "110% of State Medicaid Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Better Health Medicaid", "methodology": "case rate", "standard_charge_dollar": 89865.72, "additional_payer_notes": "110% of State Medicaid Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "case rate", "standard_charge_dollar": 81696.11, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "UBH", "plan_name": "UBH Medicaid", "methodology": "case rate", "standard_charge_dollar": 81696.11, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicaid (02/01/2023 to 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 83330.03, "additional_payer_notes": "102% of State Medicaid Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicaid", "methodology": "case rate", "standard_charge_dollar": 81696.11, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup Medicaid", "methodology": "case rate", "standard_charge_dollar": 81696.11, "additional_payer_notes": "100% of State Medicaid Rates" } ] } ] }, { "description": "Hc Drug/Substance Nos 1-3 - 80375 - 30100401", "code_information": [ { "code": "80375", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 136.8, "minimum": 16.48, "maximum": 116.28, "payers_information": [ { "payer_name": "UHC", "plan_name": "UHC Medicaid (02/01/2023 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 16.48 } ] } ] }, { "description": "OTHER SKIN, SUBCUTANEOUS TISSUE & BREAST DISORDERS - SOI : 1", "code_information": [ { "code": "3851", "type": "APR-DRG" } ], "standard_charges": [ { "setting": "inpatient", "minimum": 5439.69, "maximum": 5983.66, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Better Health - Medi Medi", "methodology": "case rate", "standard_charge_dollar": 5983.66, "additional_payer_notes": "110% of State Medicaid Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Better Health Medicaid", "methodology": "case rate", "standard_charge_dollar": 5983.66, "additional_payer_notes": "110% of State Medicaid Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "case rate", "standard_charge_dollar": 5439.69, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "UBH", "plan_name": "UBH Medicaid", "methodology": "case rate", "standard_charge_dollar": 5439.69, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicaid (02/01/2023 to 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 5548.48, "additional_payer_notes": "102% of State Medicaid Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicaid", "methodology": "case rate", "standard_charge_dollar": 5439.69, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup Medicaid", "methodology": "case rate", "standard_charge_dollar": 5439.69, "additional_payer_notes": "100% of State Medicaid Rates" } ] } ] }, { "description": "CYSTIC FIBROSIS - PULMONARY DISEASE - SOI : 3", "code_information": [ { "code": "1313", "type": "APR-DRG" } ], "standard_charges": [ { "setting": "inpatient", "minimum": 24840.89, "maximum": 27324.97, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Better Health - Medi Medi", "methodology": "case rate", "standard_charge_dollar": 27324.97, "additional_payer_notes": "110% of State Medicaid Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Better Health Medicaid", "methodology": "case rate", "standard_charge_dollar": 27324.97, "additional_payer_notes": "110% of State Medicaid Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "case rate", "standard_charge_dollar": 24840.89, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "UBH", "plan_name": "UBH Medicaid", "methodology": "case rate", "standard_charge_dollar": 24840.89, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicaid (02/01/2023 to 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 25337.7, "additional_payer_notes": "102% of State Medicaid Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicaid", "methodology": "case rate", "standard_charge_dollar": 24840.89, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup Medicaid", "methodology": "case rate", "standard_charge_dollar": 24840.89, "additional_payer_notes": "100% of State Medicaid Rates" } ] } ] }, { "description": "Hc Ercp Destruction/Lithotripsy Calculi Any Method", "code_information": [ { "code": "43265", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 25704.3, "discounted_cash": 7177.0, "minimum": 4020.0, "maximum": 21848.655, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 15215.32, "additional_payer_notes": "212.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medical Rental Network", "methodology": "fee schedule", "standard_charge_dollar": 15215.32, "additional_payer_notes": "212.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 7177.04, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "ALLY-ALIGN (FKA SPARTAN PLAN NJ, INC.)", "plan_name": "ALLY-ALIGN (FKA SPARTAN PLAN NJ, INC.)", "methodology": "fee schedule", "standard_charge_dollar": 7535.89, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Americhoice (UHC)", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 7177.04, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Amerihealth", "plan_name": "Amerihealth Medicare", "methodology": "fee schedule", "standard_charge_dollar": 7177.04, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 10546.66, "additional_payer_notes": "146.95% of Medicare Rates" }, { "payer_name": "Clover Health", "plan_name": "Clover Medicare", "methodology": "fee schedule", "standard_charge_dollar": 7177.04, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Coventry", "plan_name": "Coventry Auto", "methodology": "fee schedule", "standard_charge_dollar": 14354.08, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Coventry", "plan_name": "Coventry Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 14354.08, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "fee schedule", "standard_charge_dollar": 10047.86, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Fairprice Healthcare Holdings", "plan_name": "Fairprice Healthcare Holdings", "methodology": "fee schedule", "standard_charge_dollar": 11483.26, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ HMO POS", "methodology": "fee schedule", "standard_charge_dollar": 12724.89, "additional_payer_notes": "177.30% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ Indemnity", "methodology": "fee schedule", "standard_charge_dollar": 12724.89, "additional_payer_notes": "177.30% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ PPO", "methodology": "fee schedule", "standard_charge_dollar": 12724.89, "additional_payer_notes": "177.30% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon Medicare", "methodology": "fee schedule", "standard_charge_dollar": 7177.04, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Military Tricare", "methodology": "fee schedule", "standard_charge_dollar": 5741.63, "additional_payer_notes": "80.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 7177.04, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 7177.04, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC All Payer (02-01-2023 to 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 4415.0 }, { "payer_name": "UHC", "plan_name": "UHC Oxford (02-01-2023 to 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 4020.0 }, { "payer_name": "UHC - Adhoc", "plan_name": "UHC - Adhoc All Payer", "methodology": "case rate", "standard_charge_dollar": 4687.0 }, { "payer_name": "UHC - Adhoc", "plan_name": "UHC - Adhoc Oxford", "methodology": "case rate", "standard_charge_dollar": 4143.0 }, { "payer_name": "Wellcare", "plan_name": "Wellcare Insurance Exchange", "methodology": "fee schedule", "standard_charge_dollar": 9689.0, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 7177.04, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup Medicare", "methodology": "fee schedule", "standard_charge_dollar": 7177.04, "additional_payer_notes": "100.00% of Medicare Rates" } ] } ] }, { "description": "Hc Ro Radn Physics Consult Continuing", "code_information": [ { "code": "77336", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 761.2, "discounted_cash": 158.0, "minimum": 127.12, "maximum": 761.2, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 336.87, "additional_payer_notes": "212.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medical Rental Network", "methodology": "fee schedule", "standard_charge_dollar": 336.87, "additional_payer_notes": "212.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 158.9, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "ALLY-ALIGN (FKA SPARTAN PLAN NJ, INC.)", "plan_name": "ALLY-ALIGN (FKA SPARTAN PLAN NJ, INC.)", "methodology": "fee schedule", "standard_charge_dollar": 166.85, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Americhoice (UHC)", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 158.9, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Amerihealth", "plan_name": "Amerihealth Medicare", "methodology": "fee schedule", "standard_charge_dollar": 158.9, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 233.5, "additional_payer_notes": "146.95% of Medicare Rates" }, { "payer_name": "Clover Health", "plan_name": "Clover Medicare", "methodology": "fee schedule", "standard_charge_dollar": 158.9, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Coventry", "plan_name": "Coventry Auto", "methodology": "fee schedule", "standard_charge_dollar": 317.8, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Coventry", "plan_name": "Coventry Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 317.8, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "fee schedule", "standard_charge_dollar": 222.46, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Fairprice Healthcare Holdings", "plan_name": "Fairprice Healthcare Holdings", "methodology": "fee schedule", "standard_charge_dollar": 254.24, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ HMO POS", "methodology": "fee schedule", "standard_charge_dollar": 281.73, "additional_payer_notes": "177.30% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ Indemnity", "methodology": "fee schedule", "standard_charge_dollar": 281.73, "additional_payer_notes": "177.30% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ PPO", "methodology": "fee schedule", "standard_charge_dollar": 281.73, "additional_payer_notes": "177.30% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon Medicare", "methodology": "fee schedule", "standard_charge_dollar": 158.9, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon NJ Health Medicaid", "methodology": "percent of total billed charges", "standard_charge_percentage": 19.58, "median_amount": 149.04, "10th_percentile": 149.04, "90th_percentile": 149.04, "count": "1 through 10" }, { "payer_name": "Humana", "plan_name": "Humana Military Tricare", "methodology": "fee schedule", "standard_charge_dollar": 127.12, "additional_payer_notes": "80.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 158.9, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 158.9, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC All Payer (02-01-2023 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 761.2 }, { "payer_name": "UHC", "plan_name": "UHC Oxford (02-01-2023 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 761.2 }, { "payer_name": "UHC - Adhoc", "plan_name": "UHC - Adhoc All Payer", "methodology": "fee schedule", "standard_charge_dollar": 761.2 }, { "payer_name": "UHC - Adhoc", "plan_name": "UHC - Adhoc Oxford", "methodology": "fee schedule", "standard_charge_dollar": 761.2 }, { "payer_name": "Wellcare", "plan_name": "Wellcare Insurance Exchange", "methodology": "fee schedule", "standard_charge_dollar": 214.52, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 158.9, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellchoice", "plan_name": "WELLCHOICE HMO of NJ (Empire) Commercial (HMO / HMO POS, PPO)", "methodology": "case rate", "standard_charge_dollar": 167.0 }, { "payer_name": "Wellchoice", "plan_name": "WELLCHOICE HMO of NJ (Empire) Commercial (Indemnity)", "methodology": "case rate", "standard_charge_dollar": 202.0 }, { "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup Medicare", "methodology": "fee schedule", "standard_charge_dollar": 158.9, "additional_payer_notes": "100.00% of Medicare Rates" } ] } ] }, { "description": "UNLISTED PX FML GENITAL SYS", "code_information": [ { "code": "58999", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 6973.12, "discounted_cash": 239.0, "minimum": 191.2, "maximum": 5578.496, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 506.68, "additional_payer_notes": "212.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medical Rental Network", "methodology": "fee schedule", "standard_charge_dollar": 506.68, "additional_payer_notes": "212.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 239.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "ALLY-ALIGN (FKA SPARTAN PLAN NJ, INC.)", "plan_name": "ALLY-ALIGN (FKA SPARTAN PLAN NJ, INC.)", "methodology": "fee schedule", "standard_charge_dollar": 250.95, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Americhoice (UHC)", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 239.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Amerihealth", "plan_name": "Amerihealth Medicare", "methodology": "fee schedule", "standard_charge_dollar": 239.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 351.21, "additional_payer_notes": "146.95% of Medicare Rates" }, { "payer_name": "Clover Health", "plan_name": "Clover Medicare", "methodology": "fee schedule", "standard_charge_dollar": 239.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Coventry", "plan_name": "Coventry Auto", "methodology": "fee schedule", "standard_charge_dollar": 478.0, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Coventry", "plan_name": "Coventry Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 478.0, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "fee schedule", "standard_charge_dollar": 334.6, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Fairprice Healthcare Holdings", "plan_name": "Fairprice Healthcare Holdings", "methodology": "fee schedule", "standard_charge_dollar": 382.4, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ HMO POS", "methodology": "fee schedule", "standard_charge_dollar": 423.75, "additional_payer_notes": "177.30% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ Indemnity", "methodology": "fee schedule", "standard_charge_dollar": 423.75, "additional_payer_notes": "177.30% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ PPO", "methodology": "fee schedule", "standard_charge_dollar": 423.75, "additional_payer_notes": "177.30% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon Medicare", "methodology": "fee schedule", "standard_charge_dollar": 239.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Military Tricare", "methodology": "fee schedule", "standard_charge_dollar": 191.2, "additional_payer_notes": "80.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 239.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 239.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC All Payer (02-01-2023 to 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 3057.0 }, { "payer_name": "UHC", "plan_name": "UHC Oxford (02-01-2023 to 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 2297.0 }, { "payer_name": "UHC - Adhoc", "plan_name": "UHC - Adhoc All Payer", "methodology": "case rate", "standard_charge_dollar": 3245.0 }, { "payer_name": "UHC - Adhoc", "plan_name": "UHC - Adhoc Oxford", "methodology": "case rate", "standard_charge_dollar": 2367.0 }, { "payer_name": "Wellcare", "plan_name": "Wellcare Insurance Exchange", "methodology": "fee schedule", "standard_charge_dollar": 322.65, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 239.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellchoice", "plan_name": "WELLCHOICE HMO of NJ (Empire) Commercial (HMO / HMO POS, PPO)", "methodology": "case rate", "standard_charge_dollar": 1715.0 }, { "payer_name": "Wellchoice", "plan_name": "WELLCHOICE HMO of NJ (Empire) Commercial (Indemnity)", "methodology": "case rate", "standard_charge_dollar": 1978.0 }, { "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup Medicare", "methodology": "fee schedule", "standard_charge_dollar": 239.0, "additional_payer_notes": "100.00% of Medicare Rates" } ] } ] }, { "description": "NON-EXTENSIVE OR PROCEDURES FOR OTHER COMPLICATIONS OF TREATMENT - SOI : 2", "code_information": [ { "code": "7942", "type": "APR-DRG" } ], "standard_charges": [ { "setting": "inpatient", "minimum": 13662.43, "maximum": 15028.68, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Better Health - Medi Medi", "methodology": "case rate", "standard_charge_dollar": 15028.68, "additional_payer_notes": "110% of State Medicaid Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Better Health Medicaid", "methodology": "case rate", "standard_charge_dollar": 15028.68, "additional_payer_notes": "110% of State Medicaid Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "case rate", "standard_charge_dollar": 13662.43, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "UBH", "plan_name": "UBH Medicaid", "methodology": "case rate", "standard_charge_dollar": 13662.43, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicaid (02/01/2023 to 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 13935.68, "additional_payer_notes": "102% of State Medicaid Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicaid", "methodology": "case rate", "standard_charge_dollar": 13662.43, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup Medicaid", "methodology": "case rate", "standard_charge_dollar": 13662.43, "additional_payer_notes": "100% of State Medicaid Rates" } ] } ] }, { "description": "Exc Shoulder Tum Deep < 5 Cm", "code_information": [ { "code": "23076", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 23085.0, "discounted_cash": 3433.0, "minimum": 1715.0, "maximum": 18468.0, "payers_information": [ { "payer_name": "Humana", "plan_name": "Humana Military Tricare", "methodology": "fee schedule", "standard_charge_dollar": 2747.17, "additional_payer_notes": "80.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3433.96, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 3433.96, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC All Payer (02-01-2023 to 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 3912.0 }, { "payer_name": "UHC", "plan_name": "UHC Oxford (02-01-2023 to 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 3676.0 }, { "payer_name": "UHC - Adhoc", "plan_name": "UHC - Adhoc All Payer", "methodology": "case rate", "standard_charge_dollar": 4153.0 }, { "payer_name": "UHC - Adhoc", "plan_name": "UHC - Adhoc Oxford", "methodology": "case rate", "standard_charge_dollar": 3788.0 }, { "payer_name": "Wellcare", "plan_name": "Wellcare Insurance Exchange", "methodology": "fee schedule", "standard_charge_dollar": 4635.85, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3433.96, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellchoice", "plan_name": "WELLCHOICE HMO of NJ (Empire) Commercial (HMO / HMO POS, PPO)", "methodology": "case rate", "standard_charge_dollar": 1715.0 }, { "payer_name": "Wellchoice", "plan_name": "WELLCHOICE HMO of NJ (Empire) Commercial (Indemnity)", "methodology": "case rate", "standard_charge_dollar": 1978.0 }, { "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3433.96, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 7280.0, "additional_payer_notes": "212.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medical Rental Network", "methodology": "fee schedule", "standard_charge_dollar": 7280.0, "additional_payer_notes": "212.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3433.96, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "ALLY-ALIGN (FKA SPARTAN PLAN NJ, INC.)", "plan_name": "ALLY-ALIGN (FKA SPARTAN PLAN NJ, INC.)", "methodology": "fee schedule", "standard_charge_dollar": 3605.66, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Americhoice (UHC)", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3433.96, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Amerihealth", "plan_name": "Amerihealth Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3433.96, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 5046.2, "additional_payer_notes": "146.95% of Medicare Rates" }, { "payer_name": "Clover Health", "plan_name": "Clover Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3433.96, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Coventry", "plan_name": "Coventry Auto", "methodology": "fee schedule", "standard_charge_dollar": 6867.92, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Coventry", "plan_name": "Coventry Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 6867.92, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "fee schedule", "standard_charge_dollar": 4807.54, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Fairprice Healthcare Holdings", "plan_name": "Fairprice Healthcare Holdings", "methodology": "fee schedule", "standard_charge_dollar": 5494.34, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ HMO POS", "methodology": "fee schedule", "standard_charge_dollar": 6088.41, "additional_payer_notes": "177.30% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ Indemnity", "methodology": "fee schedule", "standard_charge_dollar": 6088.41, "additional_payer_notes": "177.30% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ PPO", "methodology": "fee schedule", "standard_charge_dollar": 6088.41, "additional_payer_notes": "177.30% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3433.96, "additional_payer_notes": "100.00% of Medicare Rates" } ] } ] }, { "description": "DISORDERS OF PERSONALITY & IMPULSE CONTROL - SOI : 3", "code_information": [ { "code": "7523", "type": "APR-DRG" } ], "standard_charges": [ { "setting": "inpatient", "minimum": 12495.88, "maximum": 13745.47, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Better Health - Medi Medi", "methodology": "case rate", "standard_charge_dollar": 13745.47, "additional_payer_notes": "110% of State Medicaid Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Better Health Medicaid", "methodology": "case rate", "standard_charge_dollar": 13745.47, "additional_payer_notes": "110% of State Medicaid Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "case rate", "standard_charge_dollar": 12495.88, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "UBH", "plan_name": "UBH Medicaid", "methodology": "case rate", "standard_charge_dollar": 12495.88, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicaid (02/01/2023 to 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 12745.8, "additional_payer_notes": "102% of State Medicaid Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicaid", "methodology": "case rate", "standard_charge_dollar": 12495.88, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup Medicaid", "methodology": "case rate", "standard_charge_dollar": 12495.88, "additional_payer_notes": "100% of State Medicaid Rates" } ] } ] }, { "description": "Hc Strapping Hand Or Finger", "code_information": [ { "code": "29280", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 294.0, "discounted_cash": 69.0, "minimum": 55.792, "maximum": 294.0, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 147.85, "additional_payer_notes": "212.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medical Rental Network", "methodology": "fee schedule", "standard_charge_dollar": 147.85, "additional_payer_notes": "212.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 69.74, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "ALLY-ALIGN (FKA SPARTAN PLAN NJ, INC.)", "plan_name": "ALLY-ALIGN (FKA SPARTAN PLAN NJ, INC.)", "methodology": "fee schedule", "standard_charge_dollar": 73.23, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Americhoice (UHC)", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 69.74, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Amerihealth", "plan_name": "Amerihealth Medicare", "methodology": "fee schedule", "standard_charge_dollar": 69.74, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 102.48, "additional_payer_notes": "146.95% of Medicare Rates" }, { "payer_name": "Clover Health", "plan_name": "Clover Medicare", "methodology": "fee schedule", "standard_charge_dollar": 69.74, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Coventry", "plan_name": "Coventry Auto", "methodology": "fee schedule", "standard_charge_dollar": 139.48, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Coventry", "plan_name": "Coventry Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 139.48, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "fee schedule", "standard_charge_dollar": 97.64, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Fairprice Healthcare Holdings", "plan_name": "Fairprice Healthcare Holdings", "methodology": "fee schedule", "standard_charge_dollar": 111.58, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ HMO POS", "methodology": "fee schedule", "standard_charge_dollar": 123.65, "additional_payer_notes": "177.30% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ Indemnity", "methodology": "fee schedule", "standard_charge_dollar": 123.65, "additional_payer_notes": "177.30% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ PPO", "methodology": "fee schedule", "standard_charge_dollar": 123.65, "additional_payer_notes": "177.30% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon Medicare", "methodology": "fee schedule", "standard_charge_dollar": 69.74, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Military Tricare", "methodology": "fee schedule", "standard_charge_dollar": 55.79, "additional_payer_notes": "80.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 69.74, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 69.74, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC All Payer (02-01-2023 to 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 294.0 }, { "payer_name": "UHC", "plan_name": "UHC Oxford (02-01-2023 to 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 294.0 }, { "payer_name": "UHC - Adhoc", "plan_name": "UHC - Adhoc All Payer", "methodology": "case rate", "standard_charge_dollar": 294.0 }, { "payer_name": "UHC - Adhoc", "plan_name": "UHC - Adhoc Oxford", "methodology": "case rate", "standard_charge_dollar": 294.0 }, { "payer_name": "Wellcare", "plan_name": "Wellcare Insurance Exchange", "methodology": "fee schedule", "standard_charge_dollar": 94.15, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 69.74, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup Medicare", "methodology": "fee schedule", "standard_charge_dollar": 69.74, "additional_payer_notes": "100.00% of Medicare Rates" } ] } ] }, { "description": "Hc Egd Flex Intraluminal Tube/Catheter Insertion", "code_information": [ { "code": "43241", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 8294.05, "discounted_cash": 2268.0, "minimum": 1583.3341, "maximum": 7049.9425, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 4809.3, "additional_payer_notes": "212.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medical Rental Network", "methodology": "fee schedule", "standard_charge_dollar": 4809.3, "additional_payer_notes": "212.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2268.54, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "ALLY-ALIGN (FKA SPARTAN PLAN NJ, INC.)", "plan_name": "ALLY-ALIGN (FKA SPARTAN PLAN NJ, INC.)", "methodology": "fee schedule", "standard_charge_dollar": 2381.97, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Americhoice (UHC)", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2268.54, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Amerihealth", "plan_name": "Amerihealth Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2268.54, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 3333.62, "additional_payer_notes": "146.95% of Medicare Rates" }, { "payer_name": "Clover Health", "plan_name": "Clover Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2268.54, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Coventry", "plan_name": "Coventry Auto", "methodology": "fee schedule", "standard_charge_dollar": 4537.08, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Coventry", "plan_name": "Coventry Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 4537.08, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "fee schedule", "standard_charge_dollar": 3175.96, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Fairprice Healthcare Holdings", "plan_name": "Fairprice Healthcare Holdings", "methodology": "fee schedule", "standard_charge_dollar": 3629.66, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ HMO POS", "methodology": "fee schedule", "standard_charge_dollar": 4022.12, "additional_payer_notes": "177.30% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ Indemnity", "methodology": "fee schedule", "standard_charge_dollar": 4022.12, "additional_payer_notes": "177.30% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ PPO", "methodology": "fee schedule", "standard_charge_dollar": 4022.12, "additional_payer_notes": "177.30% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2268.54, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Military Tricare", "methodology": "fee schedule", "standard_charge_dollar": 1814.83, "additional_payer_notes": "80.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2268.54, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 2268.54, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC All Payer (02-01-2023 to 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 3912.0 }, { "payer_name": "UHC", "plan_name": "UHC Oxford (02-01-2023 to 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 3676.0 }, { "payer_name": "UHC - Adhoc", "plan_name": "UHC - Adhoc All Payer", "methodology": "case rate", "standard_charge_dollar": 4153.0 }, { "payer_name": "UHC - Adhoc", "plan_name": "UHC - Adhoc Oxford", "methodology": "case rate", "standard_charge_dollar": 3788.0 }, { "payer_name": "Wellcare", "plan_name": "Wellcare Insurance Exchange", "methodology": "fee schedule", "standard_charge_dollar": 3062.53, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2268.54, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2268.54, "additional_payer_notes": "100.00% of Medicare Rates" } ] } ] }, { "description": "Hc Hepatitis C Virus, Genotype Anal Dna/Rna", "code_information": [ { "code": "87902", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 1103.8, "discounted_cash": 257.0, "minimum": 154.47, "maximum": 938.23, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 545.79, "additional_payer_notes": "212.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medical Rental Network", "methodology": "fee schedule", "standard_charge_dollar": 545.79, "additional_payer_notes": "212.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 257.45, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "ALLY-ALIGN (FKA SPARTAN PLAN NJ, INC.)", "plan_name": "ALLY-ALIGN (FKA SPARTAN PLAN NJ, INC.)", "methodology": "fee schedule", "standard_charge_dollar": 270.32, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Americhoice (UHC)", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 257.45, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Amerihealth", "plan_name": "Amerihealth Medicare", "methodology": "fee schedule", "standard_charge_dollar": 257.45, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 373.3, "additional_payer_notes": "Laboratory - 145.00% of Medicare Rates" }, { "payer_name": "Clover Health", "plan_name": "Clover Medicare", "methodology": "fee schedule", "standard_charge_dollar": 257.45, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Coventry", "plan_name": "Coventry Auto", "methodology": "fee schedule", "standard_charge_dollar": 514.9, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Coventry", "plan_name": "Coventry Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 514.9, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "fee schedule", "standard_charge_dollar": 360.43, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Fairprice Healthcare Holdings", "plan_name": "Fairprice Healthcare Holdings", "methodology": "fee schedule", "standard_charge_dollar": 308.94, "additional_payer_notes": "Laboratory - 120.00% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ HMO POS", "methodology": "fee schedule", "standard_charge_dollar": 779.28, "additional_payer_notes": "177.30% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ Indemnity", "methodology": "fee schedule", "standard_charge_dollar": 779.28, "additional_payer_notes": "177.30% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ PPO", "methodology": "fee schedule", "standard_charge_dollar": 779.28, "additional_payer_notes": "177.30% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon Medicare", "methodology": "fee schedule", "standard_charge_dollar": 257.45, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Military Tricare", "methodology": "fee schedule", "standard_charge_dollar": 205.96, "additional_payer_notes": "80.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 257.45, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 257.45, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC All Payer (02-01-2023 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 154.47 }, { "payer_name": "UHC", "plan_name": "UHC Medicaid (02/01/2023 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 205.96 }, { "payer_name": "UHC", "plan_name": "UHC Oxford (02-01-2023 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 154.47 }, { "payer_name": "UHC - Adhoc", "plan_name": "UHC - Adhoc All Payer", "methodology": "fee schedule", "standard_charge_dollar": 257.45 }, { "payer_name": "UHC - Adhoc", "plan_name": "UHC - Adhoc Oxford", "methodology": "fee schedule", "standard_charge_dollar": 257.45 }, { "payer_name": "Wellcare", "plan_name": "Wellcare Insurance Exchange", "methodology": "fee schedule", "standard_charge_dollar": 347.56, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 257.45, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup Medicare", "methodology": "fee schedule", "standard_charge_dollar": 257.45, "additional_payer_notes": "100.00% of Medicare Rates" } ] } ] }, { "description": "MINOR SMALL AND LARGE BOWEL PROCEDURES WITH CC", "code_information": [ { "code": "345", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 18945.0, "minimum": 10225.72, "maximum": 34291.7894, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "case rate", "standard_charge_dollar": 34291.79, "additional_payer_notes": "181.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medical Rental Network", "methodology": "case rate", "standard_charge_dollar": 34291.79, "additional_payer_notes": "181.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "case rate", "standard_charge_dollar": 15519.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "ALLY-ALIGN (FKA SPARTAN PLAN NJ, INC.)", "plan_name": "ALLY-ALIGN (FKA SPARTAN PLAN NJ, INC.)", "methodology": "case rate", "standard_charge_dollar": 19893.03, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Americhoice (UHC)", "plan_name": "UHC Medicare", "methodology": "case rate", "standard_charge_dollar": 15519.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Amerihealth", "plan_name": "Amerihealth Medicare", "methodology": "case rate", "standard_charge_dollar": 15519.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Commercial", "methodology": "case rate", "standard_charge_dollar": 22013.76 }, { "payer_name": "Clover Health", "plan_name": "Clover Medicare", "methodology": "case rate", "standard_charge_dollar": 15519.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Coventry", "plan_name": "Coventry Auto", "methodology": "case rate", "standard_charge_dollar": 32207.76, "additional_payer_notes": "170.00% of Medicare Rates" }, { "payer_name": "Coventry", "plan_name": "Coventry Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 32207.76, "additional_payer_notes": "170.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "case rate", "standard_charge_dollar": 24629.46, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Fairprice Healthcare Holdings", "plan_name": "Fairprice Healthcare Holdings", "methodology": "case rate", "standard_charge_dollar": 30313.18, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon Medicare", "methodology": "case rate", "standard_charge_dollar": 15519.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon NJ Health Medicaid", "methodology": "case rate", "standard_charge_dollar": 10225.72 }, { "payer_name": "Humana", "plan_name": "Humana Military Tricare", "methodology": "case rate", "standard_charge_dollar": 15156.59, "additional_payer_notes": "80.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 18945.74, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 18014.4 }, { "payer_name": "UBH", "plan_name": "UBH Medicare", "methodology": "case rate", "standard_charge_dollar": 15519.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC All Payer (02-01-2023 to 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 25363.22 }, { "payer_name": "UHC", "plan_name": "UHC Oxford (02-01-2023 to 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 22104.04 }, { "payer_name": "UHC - Adhoc", "plan_name": "UHC - Adhoc All Payer", "methodology": "case rate", "standard_charge_dollar": 26923.6 }, { "payer_name": "UHC - Adhoc", "plan_name": "UHC - Adhoc Oxford", "methodology": "case rate", "standard_charge_dollar": 22778.15 }, { "payer_name": "Wellcare", "plan_name": "Wellcare Insurance Exchange", "methodology": "case rate", "standard_charge_dollar": 25576.75, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "case rate", "standard_charge_dollar": 15519.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup Medicare", "methodology": "case rate", "standard_charge_dollar": 15519.6, "additional_payer_notes": "100.00% of Medicare Rates" } ] } ] }, { "description": "Hc Exc Skin Benig 2.1-3 Cm Face/Head/Mucus", "code_information": [ { "code": "11443", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 2752.0, "discounted_cash": 1952.0, "minimum": 525.3568, "maximum": 12312.0, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 2752.0, "additional_payer_notes": "212.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medical Rental Network", "methodology": "fee schedule", "standard_charge_dollar": 2752.0, "additional_payer_notes": "212.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1952.53, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "ALLY-ALIGN (FKA SPARTAN PLAN NJ, INC.)", "plan_name": "ALLY-ALIGN (FKA SPARTAN PLAN NJ, INC.)", "methodology": "fee schedule", "standard_charge_dollar": 2050.16, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Americhoice (UHC)", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1952.53, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Amerihealth", "plan_name": "Amerihealth Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1952.53, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 2752.0, "additional_payer_notes": "146.95% of Medicare Rates" }, { "payer_name": "Clover Health", "plan_name": "Clover Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1952.53, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Coventry", "plan_name": "Coventry Auto", "methodology": "fee schedule", "standard_charge_dollar": 2752.0, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Coventry", "plan_name": "Coventry Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 2752.0, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "fee schedule", "standard_charge_dollar": 2733.54, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Fairprice Healthcare Holdings", "plan_name": "Fairprice Healthcare Holdings", "methodology": "fee schedule", "standard_charge_dollar": 2752.0, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ HMO POS", "methodology": "fee schedule", "standard_charge_dollar": 2752.0, "additional_payer_notes": "177.30% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ Indemnity", "methodology": "fee schedule", "standard_charge_dollar": 2752.0, "additional_payer_notes": "177.30% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ PPO", "methodology": "fee schedule", "standard_charge_dollar": 2752.0, "additional_payer_notes": "177.30% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1952.53, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Military Tricare", "methodology": "fee schedule", "standard_charge_dollar": 1562.02, "additional_payer_notes": "80.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1952.53, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 1952.53, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC All Payer (02-01-2023 to 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 2752.0 }, { "payer_name": "UHC", "plan_name": "UHC Oxford (02-01-2023 to 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 2297.0 }, { "payer_name": "UHC - Adhoc", "plan_name": "UHC - Adhoc All Payer", "methodology": "case rate", "standard_charge_dollar": 2752.0 }, { "payer_name": "UHC - Adhoc", "plan_name": "UHC - Adhoc Oxford", "methodology": "case rate", "standard_charge_dollar": 2367.0 }, { "payer_name": "Wellcare", "plan_name": "Wellcare Insurance Exchange", "methodology": "fee schedule", "standard_charge_dollar": 2635.92, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1952.53, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellchoice", "plan_name": "WELLCHOICE HMO of NJ (Empire) Commercial (HMO / HMO POS, PPO)", "methodology": "case rate", "standard_charge_dollar": 1715.0 }, { "payer_name": "Wellchoice", "plan_name": "WELLCHOICE HMO of NJ (Empire) Commercial (Indemnity)", "methodology": "case rate", "standard_charge_dollar": 1978.0 }, { "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1952.53, "additional_payer_notes": "100.00% of Medicare Rates" } ] } ] }, { "description": "Hc Op Cardiac Rehab W Cont Ecg Monit Per Session", "code_information": [ { "code": "93798", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 590.75, "discounted_cash": 152.0, "minimum": 112.7742, "maximum": 590.75, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 323.07, "additional_payer_notes": "212.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medical Rental Network", "methodology": "fee schedule", "standard_charge_dollar": 323.07, "additional_payer_notes": "212.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 152.39, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "ALLY-ALIGN (FKA SPARTAN PLAN NJ, INC.)", "plan_name": "ALLY-ALIGN (FKA SPARTAN PLAN NJ, INC.)", "methodology": "fee schedule", "standard_charge_dollar": 160.01, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Americhoice (UHC)", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 152.39, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Amerihealth", "plan_name": "Amerihealth Medicare", "methodology": "fee schedule", "standard_charge_dollar": 152.39, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 223.94, "additional_payer_notes": "146.95% of Medicare Rates" }, { "payer_name": "Clover Health", "plan_name": "Clover Medicare", "methodology": "fee schedule", "standard_charge_dollar": 152.39, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Coventry", "plan_name": "Coventry Auto", "methodology": "fee schedule", "standard_charge_dollar": 304.78, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Coventry", "plan_name": "Coventry Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 304.78, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "fee schedule", "standard_charge_dollar": 213.35, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Fairprice Healthcare Holdings", "plan_name": "Fairprice Healthcare Holdings", "methodology": "fee schedule", "standard_charge_dollar": 243.82, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ HMO POS", "methodology": "fee schedule", "standard_charge_dollar": 270.19, "additional_payer_notes": "177.30% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ Indemnity", "methodology": "fee schedule", "standard_charge_dollar": 270.19, "additional_payer_notes": "177.30% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ PPO", "methodology": "fee schedule", "standard_charge_dollar": 270.19, "additional_payer_notes": "177.30% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon Medicare", "methodology": "fee schedule", "standard_charge_dollar": 152.39, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon NJ Health Medicaid", "methodology": "percent of total billed charges", "standard_charge_percentage": 19.58, "median_amount": 115.67, "10th_percentile": 115.67, "90th_percentile": 115.67, "count": "1 through 10" }, { "payer_name": "Humana", "plan_name": "Humana Military Tricare", "methodology": "fee schedule", "standard_charge_dollar": 121.91, "additional_payer_notes": "80.00% of Medicare Rates" }, { "payer_name": "Keenan", "plan_name": "Keenan", "methodology": "percent of total billed charges", "standard_charge_percentage": 30.0, "median_amount": 354.45, "10th_percentile": 354.45, "90th_percentile": 354.45, "count": "1 through 10" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 152.39, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 152.39, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC All Payer (02-01-2023 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 590.75 }, { "payer_name": "UHC", "plan_name": "UHC Medicaid (02/01/2023 to 12-31-2026)", "methodology": "percent of total billed charges", "standard_charge_percentage": 19.47, "median_amount": 112.37, "10th_percentile": 112.37, "90th_percentile": 112.37, "count": "1 through 10" }, { "payer_name": "UHC", "plan_name": "UHC Oxford (02-01-2023 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 590.75 }, { "payer_name": "UHC - Adhoc", "plan_name": "UHC - Adhoc All Payer", "methodology": "fee schedule", "standard_charge_dollar": 590.75 }, { "payer_name": "UHC - Adhoc", "plan_name": "UHC - Adhoc Oxford", "methodology": "fee schedule", "standard_charge_dollar": 590.75 }, { "payer_name": "Wellcare", "plan_name": "Wellcare Insurance Exchange", "methodology": "fee schedule", "standard_charge_dollar": 205.73, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 152.39, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup Medicaid", "methodology": "percent of total billed charges", "standard_charge_percentage": 19.09, "median_amount": 110.17, "10th_percentile": 110.17, "90th_percentile": 110.17, "count": "1 through 10" }, { "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup Medicare", "methodology": "fee schedule", "standard_charge_dollar": 152.39, "additional_payer_notes": "100.00% of Medicare Rates" } ] } ] }, { "description": "Hc Mammogram, Screening", "code_information": [ { "code": "77067", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 1270.0, "discounted_cash": 105.0, "minimum": 84.592, "maximum": 1079.5, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 224.17, "additional_payer_notes": "212.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medical Rental Network", "methodology": "fee schedule", "standard_charge_dollar": 224.17, "additional_payer_notes": "212.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 105.74, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "ALLY-ALIGN (FKA SPARTAN PLAN NJ, INC.)", "plan_name": "ALLY-ALIGN (FKA SPARTAN PLAN NJ, INC.)", "methodology": "fee schedule", "standard_charge_dollar": 111.03, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Americhoice (UHC)", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 105.74, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Amerihealth", "plan_name": "Amerihealth HMO", "methodology": "fee schedule", "standard_charge_dollar": 96.72 }, { "payer_name": "Amerihealth", "plan_name": "Amerihealth Medicare", "methodology": "fee schedule", "standard_charge_dollar": 105.74, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 163.9, "additional_payer_notes": "A Indicator - 155.00% of Medicare Rates" }, { "payer_name": "Clover Health", "plan_name": "Clover Medicare", "methodology": "fee schedule", "standard_charge_dollar": 105.74, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Coventry", "plan_name": "Coventry Auto", "methodology": "fee schedule", "standard_charge_dollar": 211.48, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Coventry", "plan_name": "Coventry Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 211.48, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "fee schedule", "standard_charge_dollar": 148.04, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Fairprice Healthcare Holdings", "plan_name": "Fairprice Healthcare Holdings", "methodology": "fee schedule", "standard_charge_dollar": 169.18 }, { "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ HMO POS", "methodology": "fee schedule", "standard_charge_dollar": 896.62, "additional_payer_notes": "177.30% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ Indemnity", "methodology": "fee schedule", "standard_charge_dollar": 896.62, "additional_payer_notes": "177.30% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ PPO", "methodology": "fee schedule", "standard_charge_dollar": 896.62, "additional_payer_notes": "177.30% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon Medicare", "methodology": "fee schedule", "standard_charge_dollar": 105.74, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon NJ Health Medicaid", "methodology": "percent of total billed charges", "standard_charge_percentage": 19.58, "median_amount": 248.67, "10th_percentile": 248.67, "90th_percentile": 248.67, "count": "341" }, { "payer_name": "Humana", "plan_name": "Humana Military Tricare", "methodology": "fee schedule", "standard_charge_dollar": 84.59, "additional_payer_notes": "80.00% of Medicare Rates" }, { "payer_name": "Keenan", "plan_name": "Keenan", "methodology": "percent of total billed charges", "standard_charge_percentage": 30.0, "median_amount": 381.0, "10th_percentile": 381.0, "90th_percentile": 381.0, "count": "100" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 105.74, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 105.74, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC All Payer (02-01-2023 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 144.98 }, { "payer_name": "UHC", "plan_name": "UHC Medicaid (02/01/2023 to 12-31-2026)", "methodology": "percent of total billed charges", "standard_charge_percentage": 19.47, "median_amount": 241.6, "10th_percentile": 241.6, "90th_percentile": 241.6, "count": "73" }, { "payer_name": "UHC", "plan_name": "UHC Oxford (02-01-2023 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 144.98 }, { "payer_name": "UHC - Adhoc", "plan_name": "UHC - Adhoc All Payer", "methodology": "fee schedule", "standard_charge_dollar": 96.65 }, { "payer_name": "UHC - Adhoc", "plan_name": "UHC - Adhoc Oxford", "methodology": "fee schedule", "standard_charge_dollar": 96.65 }, { "payer_name": "Wellcare", "plan_name": "Wellcare Insurance Exchange", "methodology": "fee schedule", "standard_charge_dollar": 142.75, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 105.74, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup Medicaid", "methodology": "percent of total billed charges", "standard_charge_percentage": 19.09, "median_amount": 236.86, "10th_percentile": 236.86, "90th_percentile": 236.86, "count": "54" }, { "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup Medicare", "methodology": "fee schedule", "standard_charge_dollar": 105.74, "additional_payer_notes": "100.00% of Medicare Rates" } ] } ] }, { "description": "Hc Assay Of Amitriptyline - G0480 - 30100408", "code_information": [ { "code": "G0480", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 96.0, "discounted_cash": 114.0, "minimum": 8.3996, "maximum": 754.8, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 96.0, "additional_payer_notes": "212.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medical Rental Network", "methodology": "fee schedule", "standard_charge_dollar": 96.0, "additional_payer_notes": "212.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 96.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "ALLY-ALIGN (FKA SPARTAN PLAN NJ, INC.)", "plan_name": "ALLY-ALIGN (FKA SPARTAN PLAN NJ, INC.)", "methodology": "fee schedule", "standard_charge_dollar": 96.0, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Americhoice (UHC)", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 96.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Amerihealth", "plan_name": "Amerihealth Medicare", "methodology": "fee schedule", "standard_charge_dollar": 96.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 96.0, "additional_payer_notes": "Laboratory - 145.00% of Medicare Rates" }, { "payer_name": "Clover Health", "plan_name": "Clover Medicare", "methodology": "fee schedule", "standard_charge_dollar": 96.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Coventry", "plan_name": "Coventry Auto", "methodology": "fee schedule", "standard_charge_dollar": 96.0, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Coventry", "plan_name": "Coventry Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 96.0, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "fee schedule", "standard_charge_dollar": 96.0, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Fairprice Healthcare Holdings", "plan_name": "Fairprice Healthcare Holdings", "methodology": "fee schedule", "standard_charge_dollar": 96.0, "additional_payer_notes": "Laboratory - 120.00% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ HMO POS", "methodology": "fee schedule", "standard_charge_dollar": 67.78, "additional_payer_notes": "177.30% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ Indemnity", "methodology": "fee schedule", "standard_charge_dollar": 67.78, "additional_payer_notes": "177.30% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ PPO", "methodology": "fee schedule", "standard_charge_dollar": 67.78, "additional_payer_notes": "177.30% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon Medicare", "methodology": "fee schedule", "standard_charge_dollar": 96.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Military Tricare", "methodology": "fee schedule", "standard_charge_dollar": 91.54, "additional_payer_notes": "80.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 96.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 96.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC All Payer (02-01-2023 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 68.66 }, { "payer_name": "UHC", "plan_name": "UHC Medicaid (02/01/2023 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 91.54 }, { "payer_name": "UHC", "plan_name": "UHC Oxford (02-01-2023 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 68.66 }, { "payer_name": "UHC - Adhoc", "plan_name": "UHC - Adhoc All Payer", "methodology": "fee schedule", "standard_charge_dollar": 96.0 }, { "payer_name": "UHC - Adhoc", "plan_name": "UHC - Adhoc Oxford", "methodology": "fee schedule", "standard_charge_dollar": 96.0 }, { "payer_name": "Wellcare", "plan_name": "Wellcare Insurance Exchange", "methodology": "fee schedule", "standard_charge_dollar": 96.0, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 96.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup Medicare", "methodology": "fee schedule", "standard_charge_dollar": 96.0, "additional_payer_notes": "100.00% of Medicare Rates" } ] } ] }, { "description": "Hc Rbc Sed Rate, Auto", "code_information": [ { "code": "85652", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 85.6, "discounted_cash": 2.0, "minimum": 1.62, "maximum": 72.76, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 5.72, "additional_payer_notes": "212.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medical Rental Network", "methodology": "fee schedule", "standard_charge_dollar": 5.72, "additional_payer_notes": "212.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "ALLY-ALIGN (FKA SPARTAN PLAN NJ, INC.)", "plan_name": "ALLY-ALIGN (FKA SPARTAN PLAN NJ, INC.)", "methodology": "fee schedule", "standard_charge_dollar": 2.84, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Americhoice (UHC)", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Amerihealth", "plan_name": "Amerihealth Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 3.92, "additional_payer_notes": "Laboratory - 145.00% of Medicare Rates" }, { "payer_name": "Clover Health", "plan_name": "Clover Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Coventry", "plan_name": "Coventry Auto", "methodology": "fee schedule", "standard_charge_dollar": 5.4, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Coventry", "plan_name": "Coventry Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 5.4, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "fee schedule", "standard_charge_dollar": 3.78, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Fairprice Healthcare Holdings", "plan_name": "Fairprice Healthcare Holdings", "methodology": "fee schedule", "standard_charge_dollar": 3.24, "additional_payer_notes": "Laboratory - 120.00% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ HMO POS", "methodology": "fee schedule", "standard_charge_dollar": 60.43, "additional_payer_notes": "177.30% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ Indemnity", "methodology": "fee schedule", "standard_charge_dollar": 60.43, "additional_payer_notes": "177.30% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ PPO", "methodology": "fee schedule", "standard_charge_dollar": 60.43, "additional_payer_notes": "177.30% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Military Tricare", "methodology": "fee schedule", "standard_charge_dollar": 2.16, "additional_payer_notes": "80.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 2.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC All Payer (02-01-2023 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 1.62 }, { "payer_name": "UHC", "plan_name": "UHC Medicaid (02/01/2023 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 2.16 }, { "payer_name": "UHC", "plan_name": "UHC Oxford (02-01-2023 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 1.62 }, { "payer_name": "UHC - Adhoc", "plan_name": "UHC - Adhoc All Payer", "methodology": "fee schedule", "standard_charge_dollar": 2.7 }, { "payer_name": "UHC - Adhoc", "plan_name": "UHC - Adhoc Oxford", "methodology": "fee schedule", "standard_charge_dollar": 2.7 }, { "payer_name": "Wellcare", "plan_name": "Wellcare Insurance Exchange", "methodology": "fee schedule", "standard_charge_dollar": 3.65, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup Medicaid", "methodology": "percent of total billed charges", "standard_charge_percentage": 19.09, "median_amount": 15.96, "10th_percentile": 2.7, "90th_percentile": 16.34, "count": "17" }, { "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2.7, "additional_payer_notes": "100.00% of Medicare Rates" } ] } ] }, { "description": "Hc Theraputic Apheresis, Wbc", "code_information": [ { "code": "36511", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 1550.0, "discounted_cash": 1841.0, "minimum": 295.895, "maximum": 1550.0, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 1550.0, "additional_payer_notes": "212.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medical Rental Network", "methodology": "fee schedule", "standard_charge_dollar": 1550.0, "additional_payer_notes": "212.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1550.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "ALLY-ALIGN (FKA SPARTAN PLAN NJ, INC.)", "plan_name": "ALLY-ALIGN (FKA SPARTAN PLAN NJ, INC.)", "methodology": "fee schedule", "standard_charge_dollar": 1550.0, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Americhoice (UHC)", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1550.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Amerihealth", "plan_name": "Amerihealth Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1550.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 1550.0, "additional_payer_notes": "146.95% of Medicare Rates" }, { "payer_name": "Clover Health", "plan_name": "Clover Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1550.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Coventry", "plan_name": "Coventry Auto", "methodology": "fee schedule", "standard_charge_dollar": 1550.0, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Coventry", "plan_name": "Coventry Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 1550.0, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "fee schedule", "standard_charge_dollar": 1550.0, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Fairprice Healthcare Holdings", "plan_name": "Fairprice Healthcare Holdings", "methodology": "fee schedule", "standard_charge_dollar": 1550.0, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ HMO POS", "methodology": "fee schedule", "standard_charge_dollar": 1550.0, "additional_payer_notes": "177.30% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ Indemnity", "methodology": "fee schedule", "standard_charge_dollar": 1550.0, "additional_payer_notes": "177.30% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ PPO", "methodology": "fee schedule", "standard_charge_dollar": 1550.0, "additional_payer_notes": "177.30% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1550.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Military Tricare", "methodology": "fee schedule", "standard_charge_dollar": 1472.95, "additional_payer_notes": "80.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1550.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 1550.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC All Payer (02-01-2023 to 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 1550.0 }, { "payer_name": "UHC", "plan_name": "UHC Oxford (02-01-2023 to 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 1550.0 }, { "payer_name": "UHC - Adhoc", "plan_name": "UHC - Adhoc All Payer", "methodology": "case rate", "standard_charge_dollar": 1550.0 }, { "payer_name": "UHC - Adhoc", "plan_name": "UHC - Adhoc Oxford", "methodology": "case rate", "standard_charge_dollar": 1550.0 }, { "payer_name": "Wellcare", "plan_name": "Wellcare Insurance Exchange", "methodology": "fee schedule", "standard_charge_dollar": 1550.0, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1550.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1550.0, "additional_payer_notes": "100.00% of Medicare Rates" } ] } ] }, { "description": "DISORDERS OF PANCREAS EXCEPT MALIGNANCY WITH MCC", "code_information": [ { "code": "438", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 20396.0, "minimum": 10229.47, "maximum": 36916.9048, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "case rate", "standard_charge_dollar": 36916.9, "additional_payer_notes": "181.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medical Rental Network", "methodology": "case rate", "standard_charge_dollar": 36916.9, "additional_payer_notes": "181.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "case rate", "standard_charge_dollar": 16684.2, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "ALLY-ALIGN (FKA SPARTAN PLAN NJ, INC.)", "plan_name": "ALLY-ALIGN (FKA SPARTAN PLAN NJ, INC.)", "methodology": "case rate", "standard_charge_dollar": 21415.88, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Americhoice (UHC)", "plan_name": "UHC Medicare", "methodology": "case rate", "standard_charge_dollar": 16684.2, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Amerihealth", "plan_name": "Amerihealth Medicare", "methodology": "case rate", "standard_charge_dollar": 16684.2, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Commercial", "methodology": "case rate", "standard_charge_dollar": 23849.83 }, { "payer_name": "Clover Health", "plan_name": "Clover Medicare", "methodology": "case rate", "standard_charge_dollar": 16684.2, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Coventry", "plan_name": "Coventry Auto", "methodology": "case rate", "standard_charge_dollar": 34673.34, "additional_payer_notes": "170.00% of Medicare Rates" }, { "payer_name": "Coventry", "plan_name": "Coventry Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 34673.34, "additional_payer_notes": "170.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "case rate", "standard_charge_dollar": 26514.9, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Fairprice Healthcare Holdings", "plan_name": "Fairprice Healthcare Holdings", "methodology": "case rate", "standard_charge_dollar": 32633.73, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon Medicare", "methodology": "case rate", "standard_charge_dollar": 16684.2, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon NJ Health Medicaid", "methodology": "case rate", "standard_charge_dollar": 10229.47 }, { "payer_name": "Humana", "plan_name": "Humana Military Tricare", "methodology": "case rate", "standard_charge_dollar": 16316.86, "additional_payer_notes": "80.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 20396.08, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 21398.7 }, { "payer_name": "UBH", "plan_name": "UBH Medicare", "methodology": "case rate", "standard_charge_dollar": 16684.2, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC All Payer (02-01-2023 to 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 27478.65 }, { "payer_name": "UHC", "plan_name": "UHC Oxford (02-01-2023 to 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 23947.64 }, { "payer_name": "UHC - Adhoc", "plan_name": "UHC - Adhoc All Payer", "methodology": "case rate", "standard_charge_dollar": 29169.17 }, { "payer_name": "UHC - Adhoc", "plan_name": "UHC - Adhoc Oxford", "methodology": "case rate", "standard_charge_dollar": 24677.97 }, { "payer_name": "Wellcare", "plan_name": "Wellcare Insurance Exchange", "methodology": "case rate", "standard_charge_dollar": 27534.71, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "case rate", "standard_charge_dollar": 16684.2, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup Medicare", "methodology": "case rate", "standard_charge_dollar": 16684.2, "additional_payer_notes": "100.00% of Medicare Rates" } ] } ] }, { "description": "Prep corneal endo allograft", "code_information": [ { "code": "65757", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 11540.0, "minimum": 1715.0, "maximum": 9232.0, "payers_information": [ { "payer_name": "UHC", "plan_name": "UHC All Payer (02-01-2023 to 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 3057.0 }, { "payer_name": "UHC", "plan_name": "UHC Oxford (02-01-2023 to 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 2297.0 }, { "payer_name": "UHC - Adhoc", "plan_name": "UHC - Adhoc All Payer", "methodology": "case rate", "standard_charge_dollar": 3245.0 }, { "payer_name": "UHC - Adhoc", "plan_name": "UHC - Adhoc Oxford", "methodology": "case rate", "standard_charge_dollar": 2367.0 }, { "payer_name": "Wellchoice", "plan_name": "WELLCHOICE HMO of NJ (Empire) Commercial (HMO / HMO POS, PPO)", "methodology": "case rate", "standard_charge_dollar": 1715.0 }, { "payer_name": "Wellchoice", "plan_name": "WELLCHOICE HMO of NJ (Empire) Commercial (Indemnity)", "methodology": "case rate", "standard_charge_dollar": 1978.0 } ] } ] }, { "description": "RETICULOENDOTHELIAL AND IMMUNITY DISORDERS WITHOUT CCMCC", "code_information": [ { "code": "816", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 8860.0, "minimum": 4505.91, "maximum": 16037.3421, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "case rate", "standard_charge_dollar": 16037.34, "additional_payer_notes": "181.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medical Rental Network", "methodology": "case rate", "standard_charge_dollar": 16037.34, "additional_payer_notes": "181.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "case rate", "standard_charge_dollar": 7421.38, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "ALLY-ALIGN (FKA SPARTAN PLAN NJ, INC.)", "plan_name": "ALLY-ALIGN (FKA SPARTAN PLAN NJ, INC.)", "methodology": "case rate", "standard_charge_dollar": 9303.43, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Americhoice (UHC)", "plan_name": "UHC Medicare", "methodology": "case rate", "standard_charge_dollar": 7421.38, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Amerihealth", "plan_name": "Amerihealth Medicare", "methodology": "case rate", "standard_charge_dollar": 7421.38, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Commercial", "methodology": "case rate", "standard_charge_dollar": 9246.16 }, { "payer_name": "Clover Health", "plan_name": "Clover Medicare", "methodology": "case rate", "standard_charge_dollar": 7421.38, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Coventry", "plan_name": "Coventry Auto", "methodology": "case rate", "standard_charge_dollar": 15062.7, "additional_payer_notes": "170.00% of Medicare Rates" }, { "payer_name": "Coventry", "plan_name": "Coventry Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 15062.7, "additional_payer_notes": "170.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "case rate", "standard_charge_dollar": 11518.53, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Fairprice Healthcare Holdings", "plan_name": "Fairprice Healthcare Holdings", "methodology": "case rate", "standard_charge_dollar": 14176.66, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon Medicare", "methodology": "case rate", "standard_charge_dollar": 7421.38, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon NJ Health Medicaid", "methodology": "case rate", "standard_charge_dollar": 4505.91 }, { "payer_name": "Humana", "plan_name": "Humana Military Tricare", "methodology": "case rate", "standard_charge_dollar": 7088.33, "additional_payer_notes": "80.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 8860.41, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 8113.3 }, { "payer_name": "UBH", "plan_name": "UBH Medicare", "methodology": "case rate", "standard_charge_dollar": 7421.38, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC All Payer (02-01-2023 to 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 10652.99 }, { "payer_name": "UHC", "plan_name": "UHC Oxford (02-01-2023 to 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 9284.08 }, { "payer_name": "UHC - Adhoc", "plan_name": "UHC - Adhoc All Payer", "methodology": "case rate", "standard_charge_dollar": 11308.38 }, { "payer_name": "UHC - Adhoc", "plan_name": "UHC - Adhoc Oxford", "methodology": "case rate", "standard_charge_dollar": 9567.22 }, { "payer_name": "Wellcare", "plan_name": "Wellcare Insurance Exchange", "methodology": "case rate", "standard_charge_dollar": 11961.55, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "case rate", "standard_charge_dollar": 7421.38, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup Medicare", "methodology": "case rate", "standard_charge_dollar": 7421.38, "additional_payer_notes": "100.00% of Medicare Rates" } ] } ] }, { "description": "Hc Enzyme Cell Activity", "code_information": [ { "code": "82657", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 630.0, "discounted_cash": 22.0, "minimum": 13.3, "maximum": 535.5, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 47.0, "additional_payer_notes": "212.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medical Rental Network", "methodology": "fee schedule", "standard_charge_dollar": 47.0, "additional_payer_notes": "212.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 22.17, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "ALLY-ALIGN (FKA SPARTAN PLAN NJ, INC.)", "plan_name": "ALLY-ALIGN (FKA SPARTAN PLAN NJ, INC.)", "methodology": "fee schedule", "standard_charge_dollar": 23.28, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Americhoice (UHC)", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 22.17, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Amerihealth", "plan_name": "Amerihealth Medicare", "methodology": "fee schedule", "standard_charge_dollar": 22.17, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 32.15, "additional_payer_notes": "Laboratory - 145.00% of Medicare Rates" }, { "payer_name": "Clover Health", "plan_name": "Clover Medicare", "methodology": "fee schedule", "standard_charge_dollar": 22.17, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Coventry", "plan_name": "Coventry Auto", "methodology": "fee schedule", "standard_charge_dollar": 44.34, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Coventry", "plan_name": "Coventry Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 44.34, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "fee schedule", "standard_charge_dollar": 31.04, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Fairprice Healthcare Holdings", "plan_name": "Fairprice Healthcare Holdings", "methodology": "fee schedule", "standard_charge_dollar": 26.6, "additional_payer_notes": "Laboratory - 120.00% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ HMO POS", "methodology": "fee schedule", "standard_charge_dollar": 444.78, "additional_payer_notes": "177.30% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ Indemnity", "methodology": "fee schedule", "standard_charge_dollar": 444.78, "additional_payer_notes": "177.30% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ PPO", "methodology": "fee schedule", "standard_charge_dollar": 444.78, "additional_payer_notes": "177.30% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon Medicare", "methodology": "fee schedule", "standard_charge_dollar": 22.17, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Military Tricare", "methodology": "fee schedule", "standard_charge_dollar": 17.74, "additional_payer_notes": "80.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 22.17, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 22.17, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC All Payer (02-01-2023 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 13.3 }, { "payer_name": "UHC", "plan_name": "UHC Medicaid (02/01/2023 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 17.74 }, { "payer_name": "UHC", "plan_name": "UHC Oxford (02-01-2023 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 13.3 }, { "payer_name": "UHC - Adhoc", "plan_name": "UHC - Adhoc All Payer", "methodology": "fee schedule", "standard_charge_dollar": 22.17 }, { "payer_name": "UHC - Adhoc", "plan_name": "UHC - Adhoc Oxford", "methodology": "fee schedule", "standard_charge_dollar": 22.17 }, { "payer_name": "Wellcare", "plan_name": "Wellcare Insurance Exchange", "methodology": "fee schedule", "standard_charge_dollar": 29.93, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 22.17, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup Medicare", "methodology": "fee schedule", "standard_charge_dollar": 22.17, "additional_payer_notes": "100.00% of Medicare Rates" } ] } ] }, { "description": "MAJOR CARDIOTHORACIC REPAIR OF HEART ANOMALY - SOI : 4", "code_information": [ { "code": "1604", "type": "APR-DRG" } ], "standard_charges": [ { "setting": "inpatient", "minimum": 140359.87, "maximum": 154395.86, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Better Health - Medi Medi", "methodology": "case rate", "standard_charge_dollar": 154395.86, "additional_payer_notes": "110% of State Medicaid Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Better Health Medicaid", "methodology": "case rate", "standard_charge_dollar": 154395.86, "additional_payer_notes": "110% of State Medicaid Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "case rate", "standard_charge_dollar": 140359.87, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "UBH", "plan_name": "UBH Medicaid", "methodology": "case rate", "standard_charge_dollar": 140359.87, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicaid (02/01/2023 to 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 143167.07, "additional_payer_notes": "102% of State Medicaid Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicaid", "methodology": "case rate", "standard_charge_dollar": 140359.87, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup Medicaid", "methodology": "case rate", "standard_charge_dollar": 140359.87, "additional_payer_notes": "100% of State Medicaid Rates" } ] } ] }, { "description": "MAJOR GASTROINTESTINAL DISORDERS AND PERITONEAL INFECTIONS WITH CC", "code_information": [ { "code": "372", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 13355.0, "minimum": 6484.12, "maximum": 24174.1428, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "case rate", "standard_charge_dollar": 24174.14, "additional_payer_notes": "181.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medical Rental Network", "methodology": "case rate", "standard_charge_dollar": 24174.14, "additional_payer_notes": "181.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "case rate", "standard_charge_dollar": 11031.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "ALLY-ALIGN (FKA SPARTAN PLAN NJ, INC.)", "plan_name": "ALLY-ALIGN (FKA SPARTAN PLAN NJ, INC.)", "methodology": "case rate", "standard_charge_dollar": 14023.67, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Americhoice (UHC)", "plan_name": "UHC Medicare", "methodology": "case rate", "standard_charge_dollar": 11031.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Amerihealth", "plan_name": "Amerihealth Medicare", "methodology": "case rate", "standard_charge_dollar": 11031.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Commercial", "methodology": "case rate", "standard_charge_dollar": 14937.23 }, { "payer_name": "Clover Health", "plan_name": "Clover Medicare", "methodology": "case rate", "standard_charge_dollar": 11031.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Coventry", "plan_name": "Coventry Auto", "methodology": "case rate", "standard_charge_dollar": 22705.0, "additional_payer_notes": "170.00% of Medicare Rates" }, { "payer_name": "Coventry", "plan_name": "Coventry Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 22705.0, "additional_payer_notes": "170.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "case rate", "standard_charge_dollar": 17362.64, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Fairprice Healthcare Holdings", "plan_name": "Fairprice Healthcare Holdings", "methodology": "case rate", "standard_charge_dollar": 21369.41, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon Medicare", "methodology": "case rate", "standard_charge_dollar": 11031.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon NJ Health Medicaid", "methodology": "case rate", "standard_charge_dollar": 6484.12 }, { "payer_name": "Humana", "plan_name": "Humana Military Tricare", "methodology": "case rate", "standard_charge_dollar": 10684.7, "additional_payer_notes": "80.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 13355.88, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 10698.0 }, { "payer_name": "UBH", "plan_name": "UBH Medicare", "methodology": "case rate", "standard_charge_dollar": 11031.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC All Payer (02-01-2023 to 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 17209.98 }, { "payer_name": "UHC", "plan_name": "UHC Oxford (02-01-2023 to 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 14998.49 }, { "payer_name": "UHC - Adhoc", "plan_name": "UHC - Adhoc All Payer", "methodology": "case rate", "standard_charge_dollar": 18268.75 }, { "payer_name": "UHC - Adhoc", "plan_name": "UHC - Adhoc Oxford", "methodology": "case rate", "standard_charge_dollar": 15455.9 }, { "payer_name": "Wellcare", "plan_name": "Wellcare Insurance Exchange", "methodology": "case rate", "standard_charge_dollar": 18030.44, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "case rate", "standard_charge_dollar": 11031.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup Medicare", "methodology": "case rate", "standard_charge_dollar": 11031.1, "additional_payer_notes": "100.00% of Medicare Rates" } ] } ] }, { "description": "KIDNEY AND URETER PROCEDURES FOR NON-NEOPLASM WITH CC", "code_information": [ { "code": "660", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 16830.0, "minimum": 9039.3, "maximum": 30463.9471, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "case rate", "standard_charge_dollar": 30463.95, "additional_payer_notes": "181.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medical Rental Network", "methodology": "case rate", "standard_charge_dollar": 30463.95, "additional_payer_notes": "181.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "case rate", "standard_charge_dollar": 13821.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "ALLY-ALIGN (FKA SPARTAN PLAN NJ, INC.)", "plan_name": "ALLY-ALIGN (FKA SPARTAN PLAN NJ, INC.)", "methodology": "case rate", "standard_charge_dollar": 17672.46, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Americhoice (UHC)", "plan_name": "UHC Medicare", "methodology": "case rate", "standard_charge_dollar": 13821.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Amerihealth", "plan_name": "Amerihealth Medicare", "methodology": "case rate", "standard_charge_dollar": 13821.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Commercial", "methodology": "case rate", "standard_charge_dollar": 19336.47 }, { "payer_name": "Clover Health", "plan_name": "Clover Medicare", "methodology": "case rate", "standard_charge_dollar": 13821.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Coventry", "plan_name": "Coventry Auto", "methodology": "case rate", "standard_charge_dollar": 28612.55, "additional_payer_notes": "170.00% of Medicare Rates" }, { "payer_name": "Coventry", "plan_name": "Coventry Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 28612.55, "additional_payer_notes": "170.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "case rate", "standard_charge_dollar": 21880.18, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Fairprice Healthcare Holdings", "plan_name": "Fairprice Healthcare Holdings", "methodology": "case rate", "standard_charge_dollar": 26929.46, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon Medicare", "methodology": "case rate", "standard_charge_dollar": 13821.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon NJ Health Medicaid", "methodology": "case rate", "standard_charge_dollar": 9039.3 }, { "payer_name": "Humana", "plan_name": "Humana Military Tricare", "methodology": "case rate", "standard_charge_dollar": 13464.73, "additional_payer_notes": "80.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 16830.91, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 16064.1 }, { "payer_name": "UBH", "plan_name": "UBH Medicare", "methodology": "case rate", "standard_charge_dollar": 13821.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC All Payer (02-01-2023 to 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 22278.58 }, { "payer_name": "UHC", "plan_name": "UHC Oxford (02-01-2023 to 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 19415.77 }, { "payer_name": "UHC - Adhoc", "plan_name": "UHC - Adhoc All Payer", "methodology": "case rate", "standard_charge_dollar": 23649.18 }, { "payer_name": "UHC - Adhoc", "plan_name": "UHC - Adhoc Oxford", "methodology": "case rate", "standard_charge_dollar": 20007.89 }, { "payer_name": "Wellcare", "plan_name": "Wellcare Insurance Exchange", "methodology": "case rate", "standard_charge_dollar": 22721.73, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "case rate", "standard_charge_dollar": 13821.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup Medicare", "methodology": "case rate", "standard_charge_dollar": 13821.5, "additional_payer_notes": "100.00% of Medicare Rates" } ] } ] }, { "description": "Hc Metabolic Panel,Comprehensive", "code_information": [ { "code": "80053", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 185.0, "discounted_cash": 10.0, "minimum": 6.34, "maximum": 157.25, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 22.39, "additional_payer_notes": "212.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medical Rental Network", "methodology": "fee schedule", "standard_charge_dollar": 22.39, "additional_payer_notes": "212.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 10.56, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "ALLY-ALIGN (FKA SPARTAN PLAN NJ, INC.)", "plan_name": "ALLY-ALIGN (FKA SPARTAN PLAN NJ, INC.)", "methodology": "fee schedule", "standard_charge_dollar": 11.09, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Americhoice (UHC)", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 10.56, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Amerihealth", "plan_name": "Amerihealth Medicare", "methodology": "fee schedule", "standard_charge_dollar": 10.56, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 15.31, "additional_payer_notes": "Laboratory - 145.00% of Medicare Rates" }, { "payer_name": "Clover Health", "plan_name": "Clover Medicare", "methodology": "fee schedule", "standard_charge_dollar": 10.56, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Coventry", "plan_name": "Coventry Auto", "methodology": "fee schedule", "standard_charge_dollar": 21.12, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Coventry", "plan_name": "Coventry Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 21.12, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "fee schedule", "standard_charge_dollar": 14.78, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Fairprice Healthcare Holdings", "plan_name": "Fairprice Healthcare Holdings", "methodology": "fee schedule", "standard_charge_dollar": 12.67, "additional_payer_notes": "Laboratory - 120.00% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ HMO POS", "methodology": "fee schedule", "standard_charge_dollar": 130.61, "additional_payer_notes": "177.30% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ Indemnity", "methodology": "fee schedule", "standard_charge_dollar": 130.61, "additional_payer_notes": "177.30% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ PPO", "methodology": "fee schedule", "standard_charge_dollar": 130.61, "additional_payer_notes": "177.30% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon Medicare", "methodology": "fee schedule", "standard_charge_dollar": 10.56, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Military Tricare", "methodology": "fee schedule", "standard_charge_dollar": 8.45, "additional_payer_notes": "80.00% of Medicare Rates" }, { "payer_name": "Keenan", "plan_name": "Keenan", "methodology": "percent of total billed charges", "standard_charge_percentage": 30.0, "median_amount": 392.27, "10th_percentile": 392.27, "90th_percentile": 392.27, "count": "1 through 10" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 10.56, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 10.56, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC All Payer (02-01-2023 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 6.34 }, { "payer_name": "UHC", "plan_name": "UHC Medicaid (02/01/2023 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 8.45 }, { "payer_name": "UHC", "plan_name": "UHC Oxford (02-01-2023 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 6.34 }, { "payer_name": "UHC - Adhoc", "plan_name": "UHC - Adhoc All Payer", "methodology": "fee schedule", "standard_charge_dollar": 10.56 }, { "payer_name": "UHC - Adhoc", "plan_name": "UHC - Adhoc Oxford", "methodology": "fee schedule", "standard_charge_dollar": 10.56 }, { "payer_name": "Wellcare", "plan_name": "Wellcare Insurance Exchange", "methodology": "fee schedule", "standard_charge_dollar": 14.26, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 10.56, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup Medicaid", "methodology": "percent of total billed charges", "standard_charge_percentage": 19.09, "median_amount": 34.5, "10th_percentile": 10.56, "90th_percentile": 34.5, "count": "101" }, { "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup Medicare", "methodology": "fee schedule", "standard_charge_dollar": 10.56, "additional_payer_notes": "100.00% of Medicare Rates" } ] } ] }, { "description": "OPN TX NASOMAX FX WFIXJ", "code_information": [ { "code": "21346", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 11542.5, "discounted_cash": 6998.0, "minimum": 1715.0, "maximum": 11542.5, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 11542.5, "additional_payer_notes": "212.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medical Rental Network", "methodology": "fee schedule", "standard_charge_dollar": 11542.5, "additional_payer_notes": "212.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 6998.45, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "ALLY-ALIGN (FKA SPARTAN PLAN NJ, INC.)", "plan_name": "ALLY-ALIGN (FKA SPARTAN PLAN NJ, INC.)", "methodology": "fee schedule", "standard_charge_dollar": 7348.37, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Americhoice (UHC)", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 6998.45, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Amerihealth", "plan_name": "Amerihealth Medicare", "methodology": "fee schedule", "standard_charge_dollar": 6998.45, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 10284.22, "additional_payer_notes": "146.95% of Medicare Rates" }, { "payer_name": "Clover Health", "plan_name": "Clover Medicare", "methodology": "fee schedule", "standard_charge_dollar": 6998.45, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Coventry", "plan_name": "Coventry Auto", "methodology": "fee schedule", "standard_charge_dollar": 11542.5, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Coventry", "plan_name": "Coventry Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 11542.5, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "fee schedule", "standard_charge_dollar": 9797.83, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Fairprice Healthcare Holdings", "plan_name": "Fairprice Healthcare Holdings", "methodology": "fee schedule", "standard_charge_dollar": 11197.52, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ HMO POS", "methodology": "fee schedule", "standard_charge_dollar": 11542.5, "additional_payer_notes": "177.30% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ Indemnity", "methodology": "fee schedule", "standard_charge_dollar": 11542.5, "additional_payer_notes": "177.30% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ PPO", "methodology": "fee schedule", "standard_charge_dollar": 11542.5, "additional_payer_notes": "177.30% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon Medicare", "methodology": "fee schedule", "standard_charge_dollar": 6998.45, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Military Tricare", "methodology": "fee schedule", "standard_charge_dollar": 5598.76, "additional_payer_notes": "80.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 6998.45, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 6998.45, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC All Payer (02-01-2023 to 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 4415.0 }, { "payer_name": "UHC", "plan_name": "UHC Oxford (02-01-2023 to 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 4020.0 }, { "payer_name": "UHC - Adhoc", "plan_name": "UHC - Adhoc All Payer", "methodology": "case rate", "standard_charge_dollar": 4687.0 }, { "payer_name": "UHC - Adhoc", "plan_name": "UHC - Adhoc Oxford", "methodology": "case rate", "standard_charge_dollar": 4143.0 }, { "payer_name": "Wellcare", "plan_name": "Wellcare Insurance Exchange", "methodology": "fee schedule", "standard_charge_dollar": 9447.91, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 6998.45, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellchoice", "plan_name": "WELLCHOICE HMO of NJ (Empire) Commercial (HMO / HMO POS, PPO)", "methodology": "case rate", "standard_charge_dollar": 1715.0 }, { "payer_name": "Wellchoice", "plan_name": "WELLCHOICE HMO of NJ (Empire) Commercial (Indemnity)", "methodology": "case rate", "standard_charge_dollar": 1978.0 }, { "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup Medicare", "methodology": "fee schedule", "standard_charge_dollar": 6998.45, "additional_payer_notes": "100.00% of Medicare Rates" } ] } ] }, { "description": "Exc Shoulder Les Sc 3 Cm/>", "code_information": [ { "code": "23071", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 17313.8, "discounted_cash": 1952.0, "minimum": 1562.024, "maximum": 13851.04, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 4139.36, "additional_payer_notes": "212.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medical Rental Network", "methodology": "fee schedule", "standard_charge_dollar": 4139.36, "additional_payer_notes": "212.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1952.53, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "ALLY-ALIGN (FKA SPARTAN PLAN NJ, INC.)", "plan_name": "ALLY-ALIGN (FKA SPARTAN PLAN NJ, INC.)", "methodology": "fee schedule", "standard_charge_dollar": 2050.16, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Americhoice (UHC)", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1952.53, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Amerihealth", "plan_name": "Amerihealth Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1952.53, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 2869.24, "additional_payer_notes": "146.95% of Medicare Rates" }, { "payer_name": "Clover Health", "plan_name": "Clover Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1952.53, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Coventry", "plan_name": "Coventry Auto", "methodology": "fee schedule", "standard_charge_dollar": 3905.06, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Coventry", "plan_name": "Coventry Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 3905.06, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "fee schedule", "standard_charge_dollar": 2733.54, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Fairprice Healthcare Holdings", "plan_name": "Fairprice Healthcare Holdings", "methodology": "fee schedule", "standard_charge_dollar": 3124.05, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ HMO POS", "methodology": "fee schedule", "standard_charge_dollar": 3461.84, "additional_payer_notes": "177.30% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ Indemnity", "methodology": "fee schedule", "standard_charge_dollar": 3461.84, "additional_payer_notes": "177.30% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ PPO", "methodology": "fee schedule", "standard_charge_dollar": 3461.84, "additional_payer_notes": "177.30% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1952.53, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Military Tricare", "methodology": "fee schedule", "standard_charge_dollar": 1562.02, "additional_payer_notes": "80.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1952.53, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 1952.53, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC All Payer (02-01-2023 to 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 4415.0 }, { "payer_name": "UHC", "plan_name": "UHC Oxford (02-01-2023 to 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 4020.0 }, { "payer_name": "UHC - Adhoc", "plan_name": "UHC - Adhoc All Payer", "methodology": "case rate", "standard_charge_dollar": 4687.0 }, { "payer_name": "UHC - Adhoc", "plan_name": "UHC - Adhoc Oxford", "methodology": "case rate", "standard_charge_dollar": 4143.0 }, { "payer_name": "Wellcare", "plan_name": "Wellcare Insurance Exchange", "methodology": "fee schedule", "standard_charge_dollar": 2635.92, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1952.53, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellchoice", "plan_name": "WELLCHOICE HMO of NJ (Empire) Commercial (HMO / HMO POS, PPO)", "methodology": "case rate", "standard_charge_dollar": 1715.0 }, { "payer_name": "Wellchoice", "plan_name": "WELLCHOICE HMO of NJ (Empire) Commercial (Indemnity)", "methodology": "case rate", "standard_charge_dollar": 1978.0 }, { "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1952.53, "additional_payer_notes": "100.00% of Medicare Rates" } ] } ] }, { "description": "Hc Theraputic Apheresis, Rbc", "code_information": [ { "code": "36512", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 1550.0, "discounted_cash": 1841.0, "minimum": 295.895, "maximum": 1550.0, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 1550.0, "additional_payer_notes": "212.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medical Rental Network", "methodology": "fee schedule", "standard_charge_dollar": 1550.0, "additional_payer_notes": "212.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1550.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "ALLY-ALIGN (FKA SPARTAN PLAN NJ, INC.)", "plan_name": "ALLY-ALIGN (FKA SPARTAN PLAN NJ, INC.)", "methodology": "fee schedule", "standard_charge_dollar": 1550.0, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Americhoice (UHC)", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1550.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Amerihealth", "plan_name": "Amerihealth Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1550.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 1550.0, "additional_payer_notes": "146.95% of Medicare Rates" }, { "payer_name": "Clover Health", "plan_name": "Clover Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1550.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Coventry", "plan_name": "Coventry Auto", "methodology": "fee schedule", "standard_charge_dollar": 1550.0, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Coventry", "plan_name": "Coventry Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 1550.0, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "fee schedule", "standard_charge_dollar": 1550.0, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Fairprice Healthcare Holdings", "plan_name": "Fairprice Healthcare Holdings", "methodology": "fee schedule", "standard_charge_dollar": 1550.0, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ HMO POS", "methodology": "fee schedule", "standard_charge_dollar": 1550.0, "additional_payer_notes": "177.30% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ Indemnity", "methodology": "fee schedule", "standard_charge_dollar": 1550.0, "additional_payer_notes": "177.30% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ PPO", "methodology": "fee schedule", "standard_charge_dollar": 1550.0, "additional_payer_notes": "177.30% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1550.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Military Tricare", "methodology": "fee schedule", "standard_charge_dollar": 1472.95, "additional_payer_notes": "80.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1550.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 1550.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC All Payer (02-01-2023 to 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 1550.0 }, { "payer_name": "UHC", "plan_name": "UHC Oxford (02-01-2023 to 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 1550.0 }, { "payer_name": "UHC - Adhoc", "plan_name": "UHC - Adhoc All Payer", "methodology": "case rate", "standard_charge_dollar": 1550.0 }, { "payer_name": "UHC - Adhoc", "plan_name": "UHC - Adhoc Oxford", "methodology": "case rate", "standard_charge_dollar": 1550.0 }, { "payer_name": "Wellcare", "plan_name": "Wellcare Insurance Exchange", "methodology": "fee schedule", "standard_charge_dollar": 1550.0, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1550.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1550.0, "additional_payer_notes": "100.00% of Medicare Rates" } ] } ] }, { "description": "MODERATELY EXTENSIVE O.R. PROCEDURE UNRELATED TO PRINCIPAL DIAGNOSIS- SOI : 2", "code_information": [ { "code": "9512", "type": "APR-DRG" } ], "standard_charges": [ { "setting": "inpatient", "minimum": 18635.47, "maximum": 20499.02, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Better Health - Medi Medi", "methodology": "case rate", "standard_charge_dollar": 20499.02, "additional_payer_notes": "110% of State Medicaid Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Better Health Medicaid", "methodology": "case rate", "standard_charge_dollar": 20499.02, "additional_payer_notes": "110% of State Medicaid Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "case rate", "standard_charge_dollar": 18635.47, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "UBH", "plan_name": "UBH Medicaid", "methodology": "case rate", "standard_charge_dollar": 18635.47, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicaid (02/01/2023 to 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 19008.18, "additional_payer_notes": "102% of State Medicaid Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicaid", "methodology": "case rate", "standard_charge_dollar": 18635.47, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup Medicaid", "methodology": "case rate", "standard_charge_dollar": 18635.47, "additional_payer_notes": "100% of State Medicaid Rates" } ] } ] }, { "description": "Hc Office/Outpatient New Low Mdm 30-44 Minutes - 99203 - 76100003", "code_information": [ { "code": "99203", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 831.0, "minimum": 84.64, "maximum": 706.35, "payers_information": [ { "payer_name": "Amerihealth", "plan_name": "Amerihealth HMO", "methodology": "fee schedule", "standard_charge_dollar": 84.64 }, { "payer_name": "Amerihealth", "plan_name": "Amerihealth Medicare", "methodology": "fee schedule", "standard_charge_dollar": 84.64, "additional_payer_notes": "100.00% of Medicare Rates" } ] } ] }, { "description": "Exc Neck Tum Deep < 5 Cm", "code_information": [ { "code": "21556", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 16351.9, "discounted_cash": 3433.0, "minimum": 1715.0, "maximum": 13081.52, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 7280.0, "additional_payer_notes": "212.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medical Rental Network", "methodology": "fee schedule", "standard_charge_dollar": 7280.0, "additional_payer_notes": "212.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3433.96, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "ALLY-ALIGN (FKA SPARTAN PLAN NJ, INC.)", "plan_name": "ALLY-ALIGN (FKA SPARTAN PLAN NJ, INC.)", "methodology": "fee schedule", "standard_charge_dollar": 3605.66, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Americhoice (UHC)", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3433.96, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Amerihealth", "plan_name": "Amerihealth Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3433.96, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 5046.2, "additional_payer_notes": "146.95% of Medicare Rates" }, { "payer_name": "Clover Health", "plan_name": "Clover Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3433.96, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Coventry", "plan_name": "Coventry Auto", "methodology": "fee schedule", "standard_charge_dollar": 6867.92, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Coventry", "plan_name": "Coventry Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 6867.92, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "fee schedule", "standard_charge_dollar": 4807.54, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Fairprice Healthcare Holdings", "plan_name": "Fairprice Healthcare Holdings", "methodology": "fee schedule", "standard_charge_dollar": 5494.34, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ HMO POS", "methodology": "fee schedule", "standard_charge_dollar": 6088.41, "additional_payer_notes": "177.30% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ Indemnity", "methodology": "fee schedule", "standard_charge_dollar": 6088.41, "additional_payer_notes": "177.30% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ PPO", "methodology": "fee schedule", "standard_charge_dollar": 6088.41, "additional_payer_notes": "177.30% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3433.96, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Military Tricare", "methodology": "fee schedule", "standard_charge_dollar": 2747.17, "additional_payer_notes": "80.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3433.96, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 3433.96, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC All Payer (02-01-2023 to 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 4415.0 }, { "payer_name": "UHC", "plan_name": "UHC Oxford (02-01-2023 to 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 4020.0 }, { "payer_name": "UHC - Adhoc", "plan_name": "UHC - Adhoc All Payer", "methodology": "case rate", "standard_charge_dollar": 4687.0 }, { "payer_name": "UHC - Adhoc", "plan_name": "UHC - Adhoc Oxford", "methodology": "case rate", "standard_charge_dollar": 4143.0 }, { "payer_name": "Wellcare", "plan_name": "Wellcare Insurance Exchange", "methodology": "fee schedule", "standard_charge_dollar": 4635.85, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3433.96, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellchoice", "plan_name": "WELLCHOICE HMO of NJ (Empire) Commercial (HMO / HMO POS, PPO)", "methodology": "case rate", "standard_charge_dollar": 1715.0 }, { "payer_name": "Wellchoice", "plan_name": "WELLCHOICE HMO of NJ (Empire) Commercial (Indemnity)", "methodology": "case rate", "standard_charge_dollar": 1978.0 }, { "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3433.96, "additional_payer_notes": "100.00% of Medicare Rates" } ] } ] }, { "description": "CHEMOTHERAPY FOR ACUTE LEUKEMIA - SOI : 1", "code_information": [ { "code": "6951", "type": "APR-DRG" } ], "standard_charges": [ { "setting": "inpatient", "minimum": 7525.38, "maximum": 8277.92, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Better Health - Medi Medi", "methodology": "case rate", "standard_charge_dollar": 8277.92, "additional_payer_notes": "110% of State Medicaid Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Better Health Medicaid", "methodology": "case rate", "standard_charge_dollar": 8277.92, "additional_payer_notes": "110% of State Medicaid Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "case rate", "standard_charge_dollar": 7525.38, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "UBH", "plan_name": "UBH Medicaid", "methodology": "case rate", "standard_charge_dollar": 7525.38, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicaid (02/01/2023 to 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 7675.89, "additional_payer_notes": "102% of State Medicaid Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicaid", "methodology": "case rate", "standard_charge_dollar": 7525.38, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup Medicaid", "methodology": "case rate", "standard_charge_dollar": 7525.38, "additional_payer_notes": "100% of State Medicaid Rates" } ] } ] }, { "description": "Hc Sigmoidoscopy,Decompress Volvulus", "code_information": [ { "code": "45337", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 4052.4, "discounted_cash": 1099.0, "minimum": 773.6032, "maximum": 4052.4, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 2330.73, "additional_payer_notes": "212.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medical Rental Network", "methodology": "fee schedule", "standard_charge_dollar": 2330.73, "additional_payer_notes": "212.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1099.4, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "ALLY-ALIGN (FKA SPARTAN PLAN NJ, INC.)", "plan_name": "ALLY-ALIGN (FKA SPARTAN PLAN NJ, INC.)", "methodology": "fee schedule", "standard_charge_dollar": 1154.37, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Americhoice (UHC)", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1099.4, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Amerihealth", "plan_name": "Amerihealth Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1099.4, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 1615.57, "additional_payer_notes": "146.95% of Medicare Rates" }, { "payer_name": "Clover Health", "plan_name": "Clover Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1099.4, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Coventry", "plan_name": "Coventry Auto", "methodology": "fee schedule", "standard_charge_dollar": 2198.8, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Coventry", "plan_name": "Coventry Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 2198.8, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "fee schedule", "standard_charge_dollar": 1539.16, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Fairprice Healthcare Holdings", "plan_name": "Fairprice Healthcare Holdings", "methodology": "fee schedule", "standard_charge_dollar": 1759.04, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ HMO POS", "methodology": "fee schedule", "standard_charge_dollar": 1949.24, "additional_payer_notes": "177.30% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ Indemnity", "methodology": "fee schedule", "standard_charge_dollar": 1949.24, "additional_payer_notes": "177.30% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ PPO", "methodology": "fee schedule", "standard_charge_dollar": 1949.24, "additional_payer_notes": "177.30% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1099.4, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Military Tricare", "methodology": "fee schedule", "standard_charge_dollar": 879.52, "additional_payer_notes": "80.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1099.4, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 1099.4, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC All Payer (02-01-2023 to 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 3912.0 }, { "payer_name": "UHC", "plan_name": "UHC Oxford (02-01-2023 to 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 3676.0 }, { "payer_name": "UHC - Adhoc", "plan_name": "UHC - Adhoc All Payer", "methodology": "case rate", "standard_charge_dollar": 4052.4 }, { "payer_name": "UHC - Adhoc", "plan_name": "UHC - Adhoc Oxford", "methodology": "case rate", "standard_charge_dollar": 3788.0 }, { "payer_name": "Wellcare", "plan_name": "Wellcare Insurance Exchange", "methodology": "fee schedule", "standard_charge_dollar": 1484.19, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1099.4, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1099.4, "additional_payer_notes": "100.00% of Medicare Rates" } ] } ] }, { "description": "Hc Exchange Nephrostomy Cath, Perq", "code_information": [ { "code": "50435", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 8698.75, "discounted_cash": 2471.0, "minimum": 1660.5914, "maximum": 6959.0, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 5239.07, "additional_payer_notes": "212.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medical Rental Network", "methodology": "fee schedule", "standard_charge_dollar": 5239.07, "additional_payer_notes": "212.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2471.26, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "ALLY-ALIGN (FKA SPARTAN PLAN NJ, INC.)", "plan_name": "ALLY-ALIGN (FKA SPARTAN PLAN NJ, INC.)", "methodology": "fee schedule", "standard_charge_dollar": 2594.82, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Americhoice (UHC)", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2471.26, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Amerihealth", "plan_name": "Amerihealth Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2471.26, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 3631.52, "additional_payer_notes": "146.95% of Medicare Rates" }, { "payer_name": "Clover Health", "plan_name": "Clover Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2471.26, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Coventry", "plan_name": "Coventry Auto", "methodology": "fee schedule", "standard_charge_dollar": 4942.52, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Coventry", "plan_name": "Coventry Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 4942.52, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "fee schedule", "standard_charge_dollar": 3459.76, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Fairprice Healthcare Holdings", "plan_name": "Fairprice Healthcare Holdings", "methodology": "fee schedule", "standard_charge_dollar": 3954.02, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ HMO POS", "methodology": "fee schedule", "standard_charge_dollar": 4381.54, "additional_payer_notes": "177.30% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ Indemnity", "methodology": "fee schedule", "standard_charge_dollar": 4381.54, "additional_payer_notes": "177.30% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ PPO", "methodology": "fee schedule", "standard_charge_dollar": 4381.54, "additional_payer_notes": "177.30% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2471.26, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Military Tricare", "methodology": "fee schedule", "standard_charge_dollar": 1977.01, "additional_payer_notes": "80.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2471.26, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 2471.26, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC All Payer (02-01-2023 to 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 3147.0 }, { "payer_name": "UHC", "plan_name": "UHC Oxford (02-01-2023 to 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 2297.0 }, { "payer_name": "UHC - Adhoc", "plan_name": "UHC - Adhoc All Payer", "methodology": "case rate", "standard_charge_dollar": 3341.0 }, { "payer_name": "UHC - Adhoc", "plan_name": "UHC - Adhoc Oxford", "methodology": "case rate", "standard_charge_dollar": 2367.0 }, { "payer_name": "Wellcare", "plan_name": "Wellcare Insurance Exchange", "methodology": "fee schedule", "standard_charge_dollar": 3336.2, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2471.26, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellchoice", "plan_name": "WELLCHOICE HMO of NJ (Empire) Commercial (HMO / HMO POS, PPO)", "methodology": "case rate", "standard_charge_dollar": 1715.0 }, { "payer_name": "Wellchoice", "plan_name": "WELLCHOICE HMO of NJ (Empire) Commercial (Indemnity)", "methodology": "case rate", "standard_charge_dollar": 1978.0 }, { "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2471.26, "additional_payer_notes": "100.00% of Medicare Rates" } ] } ] }, { "description": "Dbrdmt Bone 1St 20 Sq Cm/<", "code_information": [ { "code": "11044", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 16350.0, "discounted_cash": 1952.0, "minimum": 1270.6037, "maximum": 13080.0, "payers_information": [ { "payer_name": "Wellchoice", "plan_name": "WELLCHOICE HMO of NJ (Empire) Commercial (Indemnity)", "methodology": "case rate", "standard_charge_dollar": 1978.0 }, { "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1952.53, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 4139.36, "additional_payer_notes": "212.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medical Rental Network", "methodology": "fee schedule", "standard_charge_dollar": 4139.36, "additional_payer_notes": "212.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1952.53, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "ALLY-ALIGN (FKA SPARTAN PLAN NJ, INC.)", "plan_name": "ALLY-ALIGN (FKA SPARTAN PLAN NJ, INC.)", "methodology": "fee schedule", "standard_charge_dollar": 2050.16, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Americhoice (UHC)", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1952.53, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Amerihealth", "plan_name": "Amerihealth Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1952.53, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 2869.24, "additional_payer_notes": "146.95% of Medicare Rates" }, { "payer_name": "Clover Health", "plan_name": "Clover Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1952.53, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Coventry", "plan_name": "Coventry Auto", "methodology": "fee schedule", "standard_charge_dollar": 3905.06, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Coventry", "plan_name": "Coventry Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 3905.06, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "fee schedule", "standard_charge_dollar": 2733.54, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Fairprice Healthcare Holdings", "plan_name": "Fairprice Healthcare Holdings", "methodology": "fee schedule", "standard_charge_dollar": 3124.05, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ HMO POS", "methodology": "fee schedule", "standard_charge_dollar": 3461.84, "additional_payer_notes": "177.30% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ Indemnity", "methodology": "fee schedule", "standard_charge_dollar": 3461.84, "additional_payer_notes": "177.30% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ PPO", "methodology": "fee schedule", "standard_charge_dollar": 3461.84, "additional_payer_notes": "177.30% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1952.53, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Military Tricare", "methodology": "fee schedule", "standard_charge_dollar": 1562.02, "additional_payer_notes": "80.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1952.53, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 1952.53, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC All Payer (02-01-2023 to 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 3147.0 }, { "payer_name": "UHC", "plan_name": "UHC Oxford (02-01-2023 to 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 2297.0 }, { "payer_name": "UHC - Adhoc", "plan_name": "UHC - Adhoc All Payer", "methodology": "case rate", "standard_charge_dollar": 3341.0 }, { "payer_name": "UHC - Adhoc", "plan_name": "UHC - Adhoc Oxford", "methodology": "case rate", "standard_charge_dollar": 2367.0 }, { "payer_name": "Wellcare", "plan_name": "Wellcare Insurance Exchange", "methodology": "fee schedule", "standard_charge_dollar": 2635.92, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1952.53, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellchoice", "plan_name": "WELLCHOICE HMO of NJ (Empire) Commercial (HMO / HMO POS, PPO)", "methodology": "case rate", "standard_charge_dollar": 1715.0 } ] } ] }, { "description": "VIRAL ILLNESS - SOI : 2", "code_information": [ { "code": "7232", "type": "APR-DRG" } ], "standard_charges": [ { "setting": "inpatient", "minimum": 6455.44, "maximum": 7100.98, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Better Health - Medi Medi", "methodology": "case rate", "standard_charge_dollar": 7100.98, "additional_payer_notes": "110% of State Medicaid Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Better Health Medicaid", "methodology": "case rate", "standard_charge_dollar": 7100.98, "additional_payer_notes": "110% of State Medicaid Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "case rate", "standard_charge_dollar": 6455.44, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "UBH", "plan_name": "UBH Medicaid", "methodology": "case rate", "standard_charge_dollar": 6455.44, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicaid (02/01/2023 to 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 6584.55, "additional_payer_notes": "102% of State Medicaid Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicaid", "methodology": "case rate", "standard_charge_dollar": 6455.44, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup Medicaid", "methodology": "case rate", "standard_charge_dollar": 6455.44, "additional_payer_notes": "100% of State Medicaid Rates" } ] } ] }, { "description": "Hc Css Associate Degree Grp Per 15 Min", "code_information": [ { "code": "H0036", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 8.32, "minimum": 1.5883, "maximum": 33.24, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 8.32, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon NJ Health Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 8.32 }, { "payer_name": "UBH", "plan_name": "UBH Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 8.32 }, { "payer_name": "UHC", "plan_name": "UHC Medicaid (02/01/2023 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 8.32 } ] } ] }, { "description": "Hc Pathology Clinical Consultation Hi Mdm 41-60 Min", "code_information": [ { "code": "80505", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 761.6, "discounted_cash": 201.0, "minimum": 75.62, "maximum": 647.36, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 426.99, "additional_payer_notes": "212.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medical Rental Network", "methodology": "fee schedule", "standard_charge_dollar": 426.99, "additional_payer_notes": "212.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 201.41, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "ALLY-ALIGN (FKA SPARTAN PLAN NJ, INC.)", "plan_name": "ALLY-ALIGN (FKA SPARTAN PLAN NJ, INC.)", "methodology": "fee schedule", "standard_charge_dollar": 211.48, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Americhoice (UHC)", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 201.41, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Amerihealth", "plan_name": "Amerihealth Medicare", "methodology": "fee schedule", "standard_charge_dollar": 201.41, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 295.97, "additional_payer_notes": "146.95% of Medicare Rates" }, { "payer_name": "Clover Health", "plan_name": "Clover Medicare", "methodology": "fee schedule", "standard_charge_dollar": 201.41, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Coventry", "plan_name": "Coventry Auto", "methodology": "fee schedule", "standard_charge_dollar": 402.82, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Coventry", "plan_name": "Coventry Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 402.82, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "fee schedule", "standard_charge_dollar": 281.97, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Fairprice Healthcare Holdings", "plan_name": "Fairprice Healthcare Holdings", "methodology": "fee schedule", "standard_charge_dollar": 322.26, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ HMO POS", "methodology": "fee schedule", "standard_charge_dollar": 357.1, "additional_payer_notes": "177.30% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ Indemnity", "methodology": "fee schedule", "standard_charge_dollar": 357.1, "additional_payer_notes": "177.30% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ PPO", "methodology": "fee schedule", "standard_charge_dollar": 357.1, "additional_payer_notes": "177.30% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon Medicare", "methodology": "fee schedule", "standard_charge_dollar": 201.41, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Military Tricare", "methodology": "fee schedule", "standard_charge_dollar": 161.13, "additional_payer_notes": "80.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 201.41, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 201.41, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC All Payer (02-01-2023 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 91.39 }, { "payer_name": "UHC", "plan_name": "UHC Medicaid (02/01/2023 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 75.62 }, { "payer_name": "UHC", "plan_name": "UHC Oxford (02-01-2023 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 91.39 }, { "payer_name": "UHC - Adhoc", "plan_name": "UHC - Adhoc All Payer", "methodology": "fee schedule", "standard_charge_dollar": 152.32 }, { "payer_name": "UHC - Adhoc", "plan_name": "UHC - Adhoc Oxford", "methodology": "fee schedule", "standard_charge_dollar": 152.32 }, { "payer_name": "Wellcare", "plan_name": "Wellcare Insurance Exchange", "methodology": "fee schedule", "standard_charge_dollar": 271.9, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 201.41, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup Medicare", "methodology": "fee schedule", "standard_charge_dollar": 201.41, "additional_payer_notes": "100.00% of Medicare Rates" } ] } ] }, { "description": "HEMORRHAGE OR HEMATOMA DUE TO COMPLICATION - SOI : 2", "code_information": [ { "code": "8102", "type": "APR-DRG" } ], "standard_charges": [ { "setting": "inpatient", "minimum": 7899.15, "maximum": 8689.06, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Better Health - Medi Medi", "methodology": "case rate", "standard_charge_dollar": 8689.06, "additional_payer_notes": "110% of State Medicaid Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Better Health Medicaid", "methodology": "case rate", "standard_charge_dollar": 8689.06, "additional_payer_notes": "110% of State Medicaid Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "case rate", "standard_charge_dollar": 7899.15, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "UBH", "plan_name": "UBH Medicaid", "methodology": "case rate", "standard_charge_dollar": 7899.15, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicaid (02/01/2023 to 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 8057.13, "additional_payer_notes": "102% of State Medicaid Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicaid", "methodology": "case rate", "standard_charge_dollar": 7899.15, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup Medicaid", "methodology": "case rate", "standard_charge_dollar": 7899.15, "additional_payer_notes": "100% of State Medicaid Rates" } ] } ] }, { "description": "Hc Prostate Specific Antigen,Free", "code_information": [ { "code": "84154", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 67.0, "discounted_cash": 18.0, "minimum": 11.03, "maximum": 56.95, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 38.99, "additional_payer_notes": "212.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medical Rental Network", "methodology": "fee schedule", "standard_charge_dollar": 38.99, "additional_payer_notes": "212.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 18.39, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "ALLY-ALIGN (FKA SPARTAN PLAN NJ, INC.)", "plan_name": "ALLY-ALIGN (FKA SPARTAN PLAN NJ, INC.)", "methodology": "fee schedule", "standard_charge_dollar": 19.31, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Americhoice (UHC)", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 18.39, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Amerihealth", "plan_name": "Amerihealth Medicare", "methodology": "fee schedule", "standard_charge_dollar": 18.39, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 26.67, "additional_payer_notes": "Laboratory - 145.00% of Medicare Rates" }, { "payer_name": "Clover Health", "plan_name": "Clover Medicare", "methodology": "fee schedule", "standard_charge_dollar": 18.39, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Coventry", "plan_name": "Coventry Auto", "methodology": "fee schedule", "standard_charge_dollar": 36.78, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Coventry", "plan_name": "Coventry Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 36.78, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "fee schedule", "standard_charge_dollar": 25.75, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Fairprice Healthcare Holdings", "plan_name": "Fairprice Healthcare Holdings", "methodology": "fee schedule", "standard_charge_dollar": 22.07, "additional_payer_notes": "Laboratory - 120.00% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ HMO POS", "methodology": "fee schedule", "standard_charge_dollar": 47.3, "additional_payer_notes": "177.30% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ Indemnity", "methodology": "fee schedule", "standard_charge_dollar": 47.3, "additional_payer_notes": "177.30% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ PPO", "methodology": "fee schedule", "standard_charge_dollar": 47.3, "additional_payer_notes": "177.30% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon Medicare", "methodology": "fee schedule", "standard_charge_dollar": 18.39, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Military Tricare", "methodology": "fee schedule", "standard_charge_dollar": 14.71, "additional_payer_notes": "80.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 18.39, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 18.39, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC All Payer (02-01-2023 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 11.03 }, { "payer_name": "UHC", "plan_name": "UHC Medicaid (02/01/2023 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 14.71 }, { "payer_name": "UHC", "plan_name": "UHC Oxford (02-01-2023 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 11.03 }, { "payer_name": "UHC - Adhoc", "plan_name": "UHC - Adhoc All Payer", "methodology": "fee schedule", "standard_charge_dollar": 18.39 }, { "payer_name": "UHC - Adhoc", "plan_name": "UHC - Adhoc Oxford", "methodology": "fee schedule", "standard_charge_dollar": 18.39 }, { "payer_name": "Wellcare", "plan_name": "Wellcare Insurance Exchange", "methodology": "fee schedule", "standard_charge_dollar": 24.83, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 18.39, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup Medicare", "methodology": "fee schedule", "standard_charge_dollar": 18.39, "additional_payer_notes": "100.00% of Medicare Rates" } ] } ] }, { "description": "Hc Insert Pm Pulse Gen Only (Existing Leads)", "code_information": [ { "code": "33221", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 88395.1, "discounted_cash": 22771.0, "minimum": 2472.0, "maximum": 70716.08, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 48275.09, "additional_payer_notes": "212.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medical Rental Network", "methodology": "fee schedule", "standard_charge_dollar": 48275.09, "additional_payer_notes": "212.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 22771.27, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "ALLY-ALIGN (FKA SPARTAN PLAN NJ, INC.)", "plan_name": "ALLY-ALIGN (FKA SPARTAN PLAN NJ, INC.)", "methodology": "fee schedule", "standard_charge_dollar": 23909.83, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Americhoice (UHC)", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 22771.27, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Amerihealth", "plan_name": "Amerihealth Medicare", "methodology": "fee schedule", "standard_charge_dollar": 22771.27, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 33462.38, "additional_payer_notes": "146.95% of Medicare Rates" }, { "payer_name": "Clover Health", "plan_name": "Clover Medicare", "methodology": "fee schedule", "standard_charge_dollar": 22771.27, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Coventry", "plan_name": "Coventry Auto", "methodology": "fee schedule", "standard_charge_dollar": 45542.54, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Coventry", "plan_name": "Coventry Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 45542.54, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "fee schedule", "standard_charge_dollar": 31879.78, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Fairprice Healthcare Holdings", "plan_name": "Fairprice Healthcare Holdings", "methodology": "fee schedule", "standard_charge_dollar": 36434.03, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ HMO POS", "methodology": "fee schedule", "standard_charge_dollar": 40373.46, "additional_payer_notes": "177.30% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ Indemnity", "methodology": "fee schedule", "standard_charge_dollar": 40373.46, "additional_payer_notes": "177.30% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ PPO", "methodology": "fee schedule", "standard_charge_dollar": 40373.46, "additional_payer_notes": "177.30% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon Medicare", "methodology": "fee schedule", "standard_charge_dollar": 22771.27, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Military Tricare", "methodology": "fee schedule", "standard_charge_dollar": 18217.02, "additional_payer_notes": "80.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 22771.27, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 22771.27, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC All Payer (02-01-2023 to 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 7566.0 }, { "payer_name": "UHC", "plan_name": "UHC Oxford (02-01-2023 to 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 6317.0 }, { "payer_name": "UHC - Adhoc", "plan_name": "UHC - Adhoc All Payer", "methodology": "case rate", "standard_charge_dollar": 8031.0 }, { "payer_name": "UHC - Adhoc", "plan_name": "UHC - Adhoc Oxford", "methodology": "case rate", "standard_charge_dollar": 6510.0 }, { "payer_name": "Wellcare", "plan_name": "Wellcare Insurance Exchange", "methodology": "fee schedule", "standard_charge_dollar": 30741.21, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 22771.27, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellchoice", "plan_name": "WELLCHOICE HMO of NJ (Empire) Commercial (HMO / HMO POS, PPO)", "methodology": "case rate", "standard_charge_dollar": 2472.0 }, { "payer_name": "Wellchoice", "plan_name": "WELLCHOICE HMO of NJ (Empire) Commercial (Indemnity)", "methodology": "case rate", "standard_charge_dollar": 2753.0 }, { "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup Medicare", "methodology": "fee schedule", "standard_charge_dollar": 22771.27, "additional_payer_notes": "100.00% of Medicare Rates" } ] } ] }, { "description": "Hc Esophagoscopy Flx Balloon Dilat <30 Mm Diam", "code_information": [ { "code": "43220", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 7787.0, "discounted_cash": 2268.0, "minimum": 1486.5383, "maximum": 6618.95, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 4809.3, "additional_payer_notes": "212.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medical Rental Network", "methodology": "fee schedule", "standard_charge_dollar": 4809.3, "additional_payer_notes": "212.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2268.54, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "ALLY-ALIGN (FKA SPARTAN PLAN NJ, INC.)", "plan_name": "ALLY-ALIGN (FKA SPARTAN PLAN NJ, INC.)", "methodology": "fee schedule", "standard_charge_dollar": 2381.97, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Americhoice (UHC)", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2268.54, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Amerihealth", "plan_name": "Amerihealth Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2268.54, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 3333.62, "additional_payer_notes": "146.95% of Medicare Rates" }, { "payer_name": "Clover Health", "plan_name": "Clover Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2268.54, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Coventry", "plan_name": "Coventry Auto", "methodology": "fee schedule", "standard_charge_dollar": 4537.08, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Coventry", "plan_name": "Coventry Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 4537.08, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "fee schedule", "standard_charge_dollar": 3175.96, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Fairprice Healthcare Holdings", "plan_name": "Fairprice Healthcare Holdings", "methodology": "fee schedule", "standard_charge_dollar": 3629.66, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ HMO POS", "methodology": "fee schedule", "standard_charge_dollar": 4022.12, "additional_payer_notes": "177.30% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ Indemnity", "methodology": "fee schedule", "standard_charge_dollar": 4022.12, "additional_payer_notes": "177.30% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ PPO", "methodology": "fee schedule", "standard_charge_dollar": 4022.12, "additional_payer_notes": "177.30% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2268.54, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Military Tricare", "methodology": "fee schedule", "standard_charge_dollar": 1814.83, "additional_payer_notes": "80.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2268.54, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 2268.54, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC All Payer (02-01-2023 to 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 3912.0 }, { "payer_name": "UHC", "plan_name": "UHC Oxford (02-01-2023 to 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 3676.0 }, { "payer_name": "UHC - Adhoc", "plan_name": "UHC - Adhoc All Payer", "methodology": "case rate", "standard_charge_dollar": 4153.0 }, { "payer_name": "UHC - Adhoc", "plan_name": "UHC - Adhoc Oxford", "methodology": "case rate", "standard_charge_dollar": 3788.0 }, { "payer_name": "Wellcare", "plan_name": "Wellcare Insurance Exchange", "methodology": "fee schedule", "standard_charge_dollar": 3062.53, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2268.54, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2268.54, "additional_payer_notes": "100.00% of Medicare Rates" } ] } ] }, { "description": "Hc Insrt/Rep Subq Defibrillator And Lead", "code_information": [ { "code": "33270", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 164194.0, "discounted_cash": 37108.0, "minimum": 2472.0, "maximum": 131355.2, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 78669.13, "additional_payer_notes": "212.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medical Rental Network", "methodology": "fee schedule", "standard_charge_dollar": 78669.13, "additional_payer_notes": "212.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 37108.08, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "ALLY-ALIGN (FKA SPARTAN PLAN NJ, INC.)", "plan_name": "ALLY-ALIGN (FKA SPARTAN PLAN NJ, INC.)", "methodology": "fee schedule", "standard_charge_dollar": 38963.48, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Americhoice (UHC)", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 37108.08, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Amerihealth", "plan_name": "Amerihealth Medicare", "methodology": "fee schedule", "standard_charge_dollar": 37108.08, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 54530.32, "additional_payer_notes": "146.95% of Medicare Rates" }, { "payer_name": "Clover Health", "plan_name": "Clover Medicare", "methodology": "fee schedule", "standard_charge_dollar": 37108.08, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Coventry", "plan_name": "Coventry Auto", "methodology": "fee schedule", "standard_charge_dollar": 74216.16, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Coventry", "plan_name": "Coventry Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 74216.16, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "fee schedule", "standard_charge_dollar": 51951.31, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Fairprice Healthcare Holdings", "plan_name": "Fairprice Healthcare Holdings", "methodology": "fee schedule", "standard_charge_dollar": 59372.93, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ HMO POS", "methodology": "fee schedule", "standard_charge_dollar": 65792.63, "additional_payer_notes": "177.30% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ Indemnity", "methodology": "fee schedule", "standard_charge_dollar": 65792.63, "additional_payer_notes": "177.30% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ PPO", "methodology": "fee schedule", "standard_charge_dollar": 65792.63, "additional_payer_notes": "177.30% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon Medicare", "methodology": "fee schedule", "standard_charge_dollar": 37108.08, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Military Tricare", "methodology": "fee schedule", "standard_charge_dollar": 29686.46, "additional_payer_notes": "80.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 37108.08, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 37108.08, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC All Payer (02-01-2023 to 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 8250.0 }, { "payer_name": "UHC", "plan_name": "UHC Oxford (02-01-2023 to 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 6317.0 }, { "payer_name": "UHC - Adhoc", "plan_name": "UHC - Adhoc All Payer", "methodology": "case rate", "standard_charge_dollar": 8757.0 }, { "payer_name": "UHC - Adhoc", "plan_name": "UHC - Adhoc Oxford", "methodology": "case rate", "standard_charge_dollar": 6510.0 }, { "payer_name": "Wellcare", "plan_name": "Wellcare Insurance Exchange", "methodology": "fee schedule", "standard_charge_dollar": 50095.91, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 37108.08, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellchoice", "plan_name": "WELLCHOICE HMO of NJ (Empire) Commercial (HMO / HMO POS, PPO)", "methodology": "case rate", "standard_charge_dollar": 2472.0 }, { "payer_name": "Wellchoice", "plan_name": "WELLCHOICE HMO of NJ (Empire) Commercial (Indemnity)", "methodology": "case rate", "standard_charge_dollar": 2753.0 }, { "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup Medicare", "methodology": "fee schedule", "standard_charge_dollar": 37108.08, "additional_payer_notes": "100.00% of Medicare Rates" } ] } ] }, { "description": "Hc Angio Extremity Unilat", "code_information": [ { "code": "75710", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 13207.6, "discounted_cash": 3732.0, "minimum": 706.9027, "maximum": 12162.055, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 7913.51, "additional_payer_notes": "212.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medical Rental Network", "methodology": "fee schedule", "standard_charge_dollar": 7913.51, "additional_payer_notes": "212.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3732.79, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "ALLY-ALIGN (FKA SPARTAN PLAN NJ, INC.)", "plan_name": "ALLY-ALIGN (FKA SPARTAN PLAN NJ, INC.)", "methodology": "fee schedule", "standard_charge_dollar": 3919.43, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Americhoice (UHC)", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3732.79, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Amerihealth", "plan_name": "Amerihealth Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3732.79, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 5485.33, "additional_payer_notes": "146.95% of Medicare Rates" }, { "payer_name": "Clover Health", "plan_name": "Clover Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3732.79, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Coventry", "plan_name": "Coventry Auto", "methodology": "fee schedule", "standard_charge_dollar": 7465.58, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Coventry", "plan_name": "Coventry Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 7465.58, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "fee schedule", "standard_charge_dollar": 5225.91, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Fairprice Healthcare Holdings", "plan_name": "Fairprice Healthcare Holdings", "methodology": "fee schedule", "standard_charge_dollar": 5972.46, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ HMO POS", "methodology": "fee schedule", "standard_charge_dollar": 6618.24, "additional_payer_notes": "177.30% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ Indemnity", "methodology": "fee schedule", "standard_charge_dollar": 6618.24, "additional_payer_notes": "177.30% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ PPO", "methodology": "fee schedule", "standard_charge_dollar": 6618.24, "additional_payer_notes": "177.30% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3732.79, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Military Tricare", "methodology": "fee schedule", "standard_charge_dollar": 2986.23, "additional_payer_notes": "80.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3732.79, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 3732.79, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC All Payer (02-01-2023 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 4292.49 }, { "payer_name": "UHC", "plan_name": "UHC Medicaid (02/01/2023 to 12-31-2026)", "methodology": "percent of total billed charges", "standard_charge_percentage": 19.47, "median_amount": 3706.68, "10th_percentile": 3706.68, "90th_percentile": 3706.68, "count": "1 through 10" }, { "payer_name": "UHC", "plan_name": "UHC Oxford (02-01-2023 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 4292.49 }, { "payer_name": "UHC - Adhoc", "plan_name": "UHC - Adhoc All Payer", "methodology": "fee schedule", "standard_charge_dollar": 2861.66 }, { "payer_name": "UHC - Adhoc", "plan_name": "UHC - Adhoc Oxford", "methodology": "fee schedule", "standard_charge_dollar": 2861.66 }, { "payer_name": "Wellcare", "plan_name": "Wellcare Insurance Exchange", "methodology": "fee schedule", "standard_charge_dollar": 5039.27, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3732.79, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup Medicaid", "methodology": "percent of total billed charges", "standard_charge_percentage": 19.09, "median_amount": 3706.68, "10th_percentile": 3706.68, "90th_percentile": 3706.68, "count": "1 through 10" }, { "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3732.79, "additional_payer_notes": "100.00% of Medicare Rates" } ] } ] }, { "description": "UTERINE AND ADNEXA PROCEDURES FOR OVARIAN OR ADNEXAL MALIGNANCY WITH MCC", "code_information": [ { "code": "736", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 42865.0, "minimum": 25168.41, "maximum": 78246.0378, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "case rate", "standard_charge_dollar": 77586.23, "additional_payer_notes": "181.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medical Rental Network", "methodology": "case rate", "standard_charge_dollar": 77586.23, "additional_payer_notes": "181.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "case rate", "standard_charge_dollar": 34726.4, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "ALLY-ALIGN (FKA SPARTAN PLAN NJ, INC.)", "plan_name": "ALLY-ALIGN (FKA SPARTAN PLAN NJ, INC.)", "methodology": "case rate", "standard_charge_dollar": 45008.59, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Americhoice (UHC)", "plan_name": "UHC Medicare", "methodology": "case rate", "standard_charge_dollar": 34726.4, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Amerihealth", "plan_name": "Amerihealth Medicare", "methodology": "case rate", "standard_charge_dollar": 34726.4, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Commercial", "methodology": "case rate", "standard_charge_dollar": 52294.94 }, { "payer_name": "Clover Health", "plan_name": "Clover Medicare", "methodology": "case rate", "standard_charge_dollar": 34726.4, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Coventry", "plan_name": "Coventry Auto", "methodology": "case rate", "standard_charge_dollar": 72871.04, "additional_payer_notes": "170.00% of Medicare Rates" }, { "payer_name": "Coventry", "plan_name": "Coventry Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 72871.04, "additional_payer_notes": "170.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "case rate", "standard_charge_dollar": 55724.92, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Fairprice Healthcare Holdings", "plan_name": "Fairprice Healthcare Holdings", "methodology": "case rate", "standard_charge_dollar": 68584.51, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon Medicare", "methodology": "case rate", "standard_charge_dollar": 34726.4, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon NJ Health Medicaid", "methodology": "case rate", "standard_charge_dollar": 25168.41 }, { "payer_name": "Humana", "plan_name": "Humana Military Tricare", "methodology": "case rate", "standard_charge_dollar": 34292.26, "additional_payer_notes": "80.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 42865.32, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 47387.4 }, { "payer_name": "UBH", "plan_name": "UBH Medicare", "methodology": "case rate", "standard_charge_dollar": 34726.4, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC All Payer (02-01-2023 to 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 60251.77 }, { "payer_name": "UHC", "plan_name": "UHC Oxford (02-01-2023 to 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 52509.41 }, { "payer_name": "UHC - Adhoc", "plan_name": "UHC - Adhoc All Payer", "methodology": "case rate", "standard_charge_dollar": 63958.53 }, { "payer_name": "UHC - Adhoc", "plan_name": "UHC - Adhoc Oxford", "methodology": "case rate", "standard_charge_dollar": 54110.78 }, { "payer_name": "Wellcare", "plan_name": "Wellcare Insurance Exchange", "methodology": "case rate", "standard_charge_dollar": 57868.18, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "case rate", "standard_charge_dollar": 34726.4, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup Medicare", "methodology": "case rate", "standard_charge_dollar": 34726.4, "additional_payer_notes": "100.00% of Medicare Rates" } ] } ] }, { "description": "CHOLECYSTECTOMY- SOI : 3", "code_information": [ { "code": "2633", "type": "APR-DRG" } ], "standard_charges": [ { "setting": "inpatient", "minimum": 21707.24, "maximum": 23877.97, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Better Health - Medi Medi", "methodology": "case rate", "standard_charge_dollar": 23877.97, "additional_payer_notes": "110% of State Medicaid Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Better Health Medicaid", "methodology": "case rate", "standard_charge_dollar": 23877.97, "additional_payer_notes": "110% of State Medicaid Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "case rate", "standard_charge_dollar": 21707.24, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "UBH", "plan_name": "UBH Medicaid", "methodology": "case rate", "standard_charge_dollar": 21707.24, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicaid (02/01/2023 to 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 22141.39, "additional_payer_notes": "102% of State Medicaid Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicaid", "methodology": "case rate", "standard_charge_dollar": 21707.24, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup Medicaid", "methodology": "case rate", "standard_charge_dollar": 21707.24, "additional_payer_notes": "100% of State Medicaid Rates" } ] } ] }, { "description": "LAPAROSCOPIC CHOLECYSTECTOMY WITHOUT C.D.E. WITHOUT CCMCC", "code_information": [ { "code": "419", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 17340.0, "minimum": 8143.86, "maximum": 31386.3955, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "case rate", "standard_charge_dollar": 31386.4, "additional_payer_notes": "181.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medical Rental Network", "methodology": "case rate", "standard_charge_dollar": 31386.4, "additional_payer_notes": "181.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "case rate", "standard_charge_dollar": 14230.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "ALLY-ALIGN (FKA SPARTAN PLAN NJ, INC.)", "plan_name": "ALLY-ALIGN (FKA SPARTAN PLAN NJ, INC.)", "methodology": "case rate", "standard_charge_dollar": 18207.58, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Americhoice (UHC)", "plan_name": "UHC Medicare", "methodology": "case rate", "standard_charge_dollar": 14230.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Amerihealth", "plan_name": "Amerihealth Medicare", "methodology": "case rate", "standard_charge_dollar": 14230.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Commercial", "methodology": "case rate", "standard_charge_dollar": 19981.65 }, { "payer_name": "Clover Health", "plan_name": "Clover Medicare", "methodology": "case rate", "standard_charge_dollar": 14230.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Coventry", "plan_name": "Coventry Auto", "methodology": "case rate", "standard_charge_dollar": 29478.94, "additional_payer_notes": "170.00% of Medicare Rates" }, { "payer_name": "Coventry", "plan_name": "Coventry Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 29478.94, "additional_payer_notes": "170.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "case rate", "standard_charge_dollar": 22542.72, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Fairprice Healthcare Holdings", "plan_name": "Fairprice Healthcare Holdings", "methodology": "case rate", "standard_charge_dollar": 27744.88, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon Medicare", "methodology": "case rate", "standard_charge_dollar": 14230.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon NJ Health Medicaid", "methodology": "case rate", "standard_charge_dollar": 8143.86 }, { "payer_name": "Humana", "plan_name": "Humana Military Tricare", "methodology": "case rate", "standard_charge_dollar": 13872.44, "additional_payer_notes": "80.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 17340.55, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 20504.8 }, { "payer_name": "UBH", "plan_name": "UBH Medicare", "methodology": "case rate", "standard_charge_dollar": 14230.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC All Payer (02-01-2023 to 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 23021.92 }, { "payer_name": "UHC", "plan_name": "UHC Oxford (02-01-2023 to 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 20063.6 }, { "payer_name": "UHC - Adhoc", "plan_name": "UHC - Adhoc All Payer", "methodology": "case rate", "standard_charge_dollar": 24438.26 }, { "payer_name": "UHC - Adhoc", "plan_name": "UHC - Adhoc Oxford", "methodology": "case rate", "standard_charge_dollar": 20675.48 }, { "payer_name": "Wellcare", "plan_name": "Wellcare Insurance Exchange", "methodology": "case rate", "standard_charge_dollar": 23409.74, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "case rate", "standard_charge_dollar": 14230.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup Medicare", "methodology": "case rate", "standard_charge_dollar": 14230.7, "additional_payer_notes": "100.00% of Medicare Rates" } ] } ] }, { "description": "FULL THICKNESS BURN WITH SKIN GRAFT OR INHALATION INJURY WITHOUT CCMCC", "code_information": [ { "code": "929", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 38777.0, "minimum": 18559.41, "maximum": 70187.818, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "case rate", "standard_charge_dollar": 70187.82, "additional_payer_notes": "181.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medical Rental Network", "methodology": "case rate", "standard_charge_dollar": 70187.82, "additional_payer_notes": "181.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "case rate", "standard_charge_dollar": 31444.2, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "ALLY-ALIGN (FKA SPARTAN PLAN NJ, INC.)", "plan_name": "ALLY-ALIGN (FKA SPARTAN PLAN NJ, INC.)", "methodology": "case rate", "standard_charge_dollar": 40716.69, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Americhoice (UHC)", "plan_name": "UHC Medicare", "methodology": "case rate", "standard_charge_dollar": 31444.2, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Amerihealth", "plan_name": "Amerihealth Medicare", "methodology": "case rate", "standard_charge_dollar": 31444.2, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Commercial", "methodology": "case rate", "standard_charge_dollar": 47120.3 }, { "payer_name": "Clover Health", "plan_name": "Clover Medicare", "methodology": "case rate", "standard_charge_dollar": 31444.2, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Coventry", "plan_name": "Coventry Auto", "methodology": "case rate", "standard_charge_dollar": 65922.26, "additional_payer_notes": "170.00% of Medicare Rates" }, { "payer_name": "Coventry", "plan_name": "Coventry Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 65922.26, "additional_payer_notes": "170.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "case rate", "standard_charge_dollar": 50411.14, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Fairprice Healthcare Holdings", "plan_name": "Fairprice Healthcare Holdings", "methodology": "case rate", "standard_charge_dollar": 62044.48, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon Medicare", "methodology": "case rate", "standard_charge_dollar": 31444.2, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon NJ Health Medicaid", "methodology": "case rate", "standard_charge_dollar": 18559.41 }, { "payer_name": "Humana", "plan_name": "Humana Military Tricare", "methodology": "case rate", "standard_charge_dollar": 31022.24, "additional_payer_notes": "80.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 38777.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 22836.5 }, { "payer_name": "UBH", "plan_name": "UBH Medicare", "methodology": "case rate", "standard_charge_dollar": 31444.2, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC All Payer (02-01-2023 to 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 54289.8 }, { "payer_name": "UHC", "plan_name": "UHC Oxford (02-01-2023 to 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 47313.55 }, { "payer_name": "UHC - Adhoc", "plan_name": "UHC - Adhoc All Payer", "methodology": "case rate", "standard_charge_dollar": 57629.77 }, { "payer_name": "UHC - Adhoc", "plan_name": "UHC - Adhoc Oxford", "methodology": "case rate", "standard_charge_dollar": 48756.47 }, { "payer_name": "Wellcare", "plan_name": "Wellcare Insurance Exchange", "methodology": "case rate", "standard_charge_dollar": 52350.03, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "case rate", "standard_charge_dollar": 31444.2, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup Medicare", "methodology": "case rate", "standard_charge_dollar": 31444.2, "additional_payer_notes": "100.00% of Medicare Rates" } ] } ] }, { "description": "CONCUSSION, CLOSED SKULL FX NOS,UNCOMPLICATED INTRACRANIAL INJURY, COMA < 1 HR OR NO COMA - SOI : 1", "code_information": [ { "code": "0571", "type": "APR-DRG" } ], "standard_charges": [ { "setting": "inpatient", "minimum": 6775.16, "maximum": 7452.67, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Better Health - Medi Medi", "methodology": "case rate", "standard_charge_dollar": 7452.67, "additional_payer_notes": "110% of State Medicaid Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Better Health Medicaid", "methodology": "case rate", "standard_charge_dollar": 7452.67, "additional_payer_notes": "110% of State Medicaid Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "case rate", "standard_charge_dollar": 6775.16, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "UBH", "plan_name": "UBH Medicaid", "methodology": "case rate", "standard_charge_dollar": 6775.16, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicaid (02/01/2023 to 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 6910.66, "additional_payer_notes": "102% of State Medicaid Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicaid", "methodology": "case rate", "standard_charge_dollar": 6775.16, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup Medicaid", "methodology": "case rate", "standard_charge_dollar": 6775.16, "additional_payer_notes": "100% of State Medicaid Rates" } ] } ] }, { "description": "CHRONIC KIDNEY DISEASE - SOI : 3", "code_information": [ { "code": "4703", "type": "APR-DRG" } ], "standard_charges": [ { "setting": "inpatient", "minimum": 10860.07, "maximum": 11946.08, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Better Health - Medi Medi", "methodology": "case rate", "standard_charge_dollar": 11946.08, "additional_payer_notes": "110% of State Medicaid Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Better Health Medicaid", "methodology": "case rate", "standard_charge_dollar": 11946.08, "additional_payer_notes": "110% of State Medicaid Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "case rate", "standard_charge_dollar": 10860.07, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "UBH", "plan_name": "UBH Medicaid", "methodology": "case rate", "standard_charge_dollar": 10860.07, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicaid (02/01/2023 to 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 11077.27, "additional_payer_notes": "102% of State Medicaid Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicaid", "methodology": "case rate", "standard_charge_dollar": 10860.07, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup Medicaid", "methodology": "case rate", "standard_charge_dollar": 10860.07, "additional_payer_notes": "100% of State Medicaid Rates" } ] } ] }, { "description": "Hc Electrophys Ev,R A-V Pace/Rec,W/O Induct", "code_information": [ { "code": "93620", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 30659.1, "discounted_cash": 9220.0, "minimum": 2472.0, "maximum": 24527.28, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 19548.1, "additional_payer_notes": "212.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medical Rental Network", "methodology": "fee schedule", "standard_charge_dollar": 19548.1, "additional_payer_notes": "212.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 9220.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "ALLY-ALIGN (FKA SPARTAN PLAN NJ, INC.)", "plan_name": "ALLY-ALIGN (FKA SPARTAN PLAN NJ, INC.)", "methodology": "fee schedule", "standard_charge_dollar": 9681.84, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Americhoice (UHC)", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 9220.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Amerihealth", "plan_name": "Amerihealth Medicare", "methodology": "fee schedule", "standard_charge_dollar": 9220.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 13549.97, "additional_payer_notes": "146.95% of Medicare Rates" }, { "payer_name": "Clover Health", "plan_name": "Clover Medicare", "methodology": "fee schedule", "standard_charge_dollar": 9220.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Coventry", "plan_name": "Coventry Auto", "methodology": "fee schedule", "standard_charge_dollar": 18441.6, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Coventry", "plan_name": "Coventry Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 18441.6, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "fee schedule", "standard_charge_dollar": 12909.12, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Fairprice Healthcare Holdings", "plan_name": "Fairprice Healthcare Holdings", "methodology": "fee schedule", "standard_charge_dollar": 14753.28, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ HMO POS", "methodology": "fee schedule", "standard_charge_dollar": 16348.48, "additional_payer_notes": "177.30% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ Indemnity", "methodology": "fee schedule", "standard_charge_dollar": 16348.48, "additional_payer_notes": "177.30% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ PPO", "methodology": "fee schedule", "standard_charge_dollar": 16348.48, "additional_payer_notes": "177.30% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon Medicare", "methodology": "fee schedule", "standard_charge_dollar": 9220.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Military Tricare", "methodology": "fee schedule", "standard_charge_dollar": 7376.64, "additional_payer_notes": "80.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 9220.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 9220.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC All Payer (02-01-2023 to 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 6624.0 }, { "payer_name": "UHC", "plan_name": "UHC Oxford (02-01-2023 to 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 6317.0 }, { "payer_name": "UHC - Adhoc", "plan_name": "UHC - Adhoc All Payer", "methodology": "case rate", "standard_charge_dollar": 7031.0 }, { "payer_name": "UHC - Adhoc", "plan_name": "UHC - Adhoc Oxford", "methodology": "case rate", "standard_charge_dollar": 6510.0 }, { "payer_name": "Wellcare", "plan_name": "Wellcare Insurance Exchange", "methodology": "fee schedule", "standard_charge_dollar": 12448.08, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 9220.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellchoice", "plan_name": "WELLCHOICE HMO of NJ (Empire) Commercial (HMO / HMO POS, PPO)", "methodology": "case rate", "standard_charge_dollar": 2472.0 }, { "payer_name": "Wellchoice", "plan_name": "WELLCHOICE HMO of NJ (Empire) Commercial (Indemnity)", "methodology": "case rate", "standard_charge_dollar": 2753.0 }, { "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup Medicare", "methodology": "fee schedule", "standard_charge_dollar": 9220.8, "additional_payer_notes": "100.00% of Medicare Rates" } ] } ] }, { "description": "MULTIPLE SCLEROSIS, OTHER DEMYELINATING DISEASE AND INFLAMMATORY NEUROPATHIES- SOI : 1", "code_information": [ { "code": "0431", "type": "APR-DRG" } ], "standard_charges": [ { "setting": "inpatient", "minimum": 10319.99, "maximum": 11351.99, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Better Health - Medi Medi", "methodology": "case rate", "standard_charge_dollar": 11351.99, "additional_payer_notes": "110% of State Medicaid Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Better Health Medicaid", "methodology": "case rate", "standard_charge_dollar": 11351.99, "additional_payer_notes": "110% of State Medicaid Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "case rate", "standard_charge_dollar": 10319.99, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "UBH", "plan_name": "UBH Medicaid", "methodology": "case rate", "standard_charge_dollar": 10319.99, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicaid (02/01/2023 to 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 10526.39, "additional_payer_notes": "102% of State Medicaid Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicaid", "methodology": "case rate", "standard_charge_dollar": 10319.99, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup Medicaid", "methodology": "case rate", "standard_charge_dollar": 10319.99, "additional_payer_notes": "100% of State Medicaid Rates" } ] } ] }, { "description": "Hc Necropsy Complete, Still/Newborn W Brain", "code_information": [ { "code": "88029", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 1604.0, "minimum": 124.29, "maximum": 1363.4, "payers_information": [ { "payer_name": "UHC", "plan_name": "UHC All Payer (02-01-2023 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 124.29 }, { "payer_name": "UHC", "plan_name": "UHC Oxford (02-01-2023 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 124.29 }, { "payer_name": "UHC - Adhoc", "plan_name": "UHC - Adhoc All Payer", "methodology": "fee schedule", "standard_charge_dollar": 207.15 }, { "payer_name": "UHC - Adhoc", "plan_name": "UHC - Adhoc Oxford", "methodology": "fee schedule", "standard_charge_dollar": 207.15 } ] } ] }, { "description": "Hc Fecal Microbiota Prep And Instillation - G0455 - 75000127", "code_information": [ { "code": "G0455", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 757.88, "discounted_cash": 1099.0, "minimum": 144.6793, "maximum": 757.88, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 757.88, "additional_payer_notes": "212.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medical Rental Network", "methodology": "fee schedule", "standard_charge_dollar": 757.88, "additional_payer_notes": "212.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 757.88, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "ALLY-ALIGN (FKA SPARTAN PLAN NJ, INC.)", "plan_name": "ALLY-ALIGN (FKA SPARTAN PLAN NJ, INC.)", "methodology": "fee schedule", "standard_charge_dollar": 757.88, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Americhoice (UHC)", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 757.88, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Amerihealth", "plan_name": "Amerihealth Medicare", "methodology": "fee schedule", "standard_charge_dollar": 757.88, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 757.88, "additional_payer_notes": "146.95% of Medicare Rates" }, { "payer_name": "Clover Health", "plan_name": "Clover Medicare", "methodology": "fee schedule", "standard_charge_dollar": 757.88, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Coventry", "plan_name": "Coventry Auto", "methodology": "fee schedule", "standard_charge_dollar": 757.88, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Coventry", "plan_name": "Coventry Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 757.88, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "fee schedule", "standard_charge_dollar": 757.88, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Fairprice Healthcare Holdings", "plan_name": "Fairprice Healthcare Holdings", "methodology": "fee schedule", "standard_charge_dollar": 757.88, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ HMO POS", "methodology": "fee schedule", "standard_charge_dollar": 757.88, "additional_payer_notes": "177.30% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ Indemnity", "methodology": "fee schedule", "standard_charge_dollar": 757.88, "additional_payer_notes": "177.30% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ PPO", "methodology": "fee schedule", "standard_charge_dollar": 757.88, "additional_payer_notes": "177.30% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon Medicare", "methodology": "fee schedule", "standard_charge_dollar": 757.88, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Military Tricare", "methodology": "fee schedule", "standard_charge_dollar": 757.88, "additional_payer_notes": "80.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 757.88, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 757.88, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Insurance Exchange", "methodology": "fee schedule", "standard_charge_dollar": 757.88, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 757.88, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup Medicare", "methodology": "fee schedule", "standard_charge_dollar": 757.88, "additional_payer_notes": "100.00% of Medicare Rates" } ] } ] }, { "description": "OTHER ANEMIA & DISORDERS OF BLOOD & BLOOD-FORMING ORGANS - SOI : 1", "code_information": [ { "code": "6631", "type": "APR-DRG" } ], "standard_charges": [ { "setting": "inpatient", "minimum": 6005.56, "maximum": 6606.12, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Better Health - Medi Medi", "methodology": "case rate", "standard_charge_dollar": 6606.12, "additional_payer_notes": "110% of State Medicaid Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Better Health Medicaid", "methodology": "case rate", "standard_charge_dollar": 6606.12, "additional_payer_notes": "110% of State Medicaid Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "case rate", "standard_charge_dollar": 6005.56, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "UBH", "plan_name": "UBH Medicaid", "methodology": "case rate", "standard_charge_dollar": 6005.56, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicaid (02/01/2023 to 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 6125.67, "additional_payer_notes": "102% of State Medicaid Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicaid", "methodology": "case rate", "standard_charge_dollar": 6005.56, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup Medicaid", "methodology": "case rate", "standard_charge_dollar": 6005.56, "additional_payer_notes": "100% of State Medicaid Rates" } ] } ] }, { "description": "Hc Ultraviolet Therapy", "code_information": [ { "code": "97028", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 77.7, "discounted_cash": 9.0, "minimum": 7.52, "maximum": 77.7, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 19.93, "additional_payer_notes": "212.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medical Rental Network", "methodology": "fee schedule", "standard_charge_dollar": 19.93, "additional_payer_notes": "212.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 9.4, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "ALLY-ALIGN (FKA SPARTAN PLAN NJ, INC.)", "plan_name": "ALLY-ALIGN (FKA SPARTAN PLAN NJ, INC.)", "methodology": "fee schedule", "standard_charge_dollar": 9.87, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Americhoice (UHC)", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 9.4, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Amerihealth", "plan_name": "Amerihealth Medicare", "methodology": "fee schedule", "standard_charge_dollar": 9.4, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 77.7, "additional_payer_notes": "A Indicator - 155.00% of Medicare Rates" }, { "payer_name": "Clover Health", "plan_name": "Clover Medicare", "methodology": "fee schedule", "standard_charge_dollar": 9.4, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Coventry", "plan_name": "Coventry Auto", "methodology": "fee schedule", "standard_charge_dollar": 18.8, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Coventry", "plan_name": "Coventry Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 18.8, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "fee schedule", "standard_charge_dollar": 13.16, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Fairprice Healthcare Holdings", "plan_name": "Fairprice Healthcare Holdings", "methodology": "fee schedule", "standard_charge_dollar": 15.04 }, { "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ HMO POS", "methodology": "fee schedule", "standard_charge_dollar": 54.86, "additional_payer_notes": "177.30% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ Indemnity", "methodology": "fee schedule", "standard_charge_dollar": 54.86, "additional_payer_notes": "177.30% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ PPO", "methodology": "fee schedule", "standard_charge_dollar": 54.86, "additional_payer_notes": "177.30% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon Medicare", "methodology": "fee schedule", "standard_charge_dollar": 9.4, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Military Tricare", "methodology": "fee schedule", "standard_charge_dollar": 7.52, "additional_payer_notes": "80.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 9.4, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 9.4, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC All Payer (02-01-2023 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 77.7 }, { "payer_name": "UHC", "plan_name": "UHC Oxford (02-01-2023 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 77.7 }, { "payer_name": "UHC - Adhoc", "plan_name": "UHC - Adhoc All Payer", "methodology": "fee schedule", "standard_charge_dollar": 77.7 }, { "payer_name": "UHC - Adhoc", "plan_name": "UHC - Adhoc Oxford", "methodology": "fee schedule", "standard_charge_dollar": 77.7 }, { "payer_name": "Wellcare", "plan_name": "Wellcare Insurance Exchange", "methodology": "fee schedule", "standard_charge_dollar": 12.69, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 9.4, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup Medicare", "methodology": "fee schedule", "standard_charge_dollar": 9.4, "additional_payer_notes": "100.00% of Medicare Rates" } ] } ] }, { "description": "Hc Assay For Calprotectin Fecal", "code_information": [ { "code": "83993", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 400.0, "discounted_cash": 19.0, "minimum": 11.78, "maximum": 340.0, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 41.62, "additional_payer_notes": "212.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medical Rental Network", "methodology": "fee schedule", "standard_charge_dollar": 41.62, "additional_payer_notes": "212.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 19.63, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "ALLY-ALIGN (FKA SPARTAN PLAN NJ, INC.)", "plan_name": "ALLY-ALIGN (FKA SPARTAN PLAN NJ, INC.)", "methodology": "fee schedule", "standard_charge_dollar": 20.61, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Americhoice (UHC)", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 19.63, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Amerihealth", "plan_name": "Amerihealth Medicare", "methodology": "fee schedule", "standard_charge_dollar": 19.63, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 28.46, "additional_payer_notes": "Laboratory - 145.00% of Medicare Rates" }, { "payer_name": "Clover Health", "plan_name": "Clover Medicare", "methodology": "fee schedule", "standard_charge_dollar": 19.63, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Coventry", "plan_name": "Coventry Auto", "methodology": "fee schedule", "standard_charge_dollar": 39.26, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Coventry", "plan_name": "Coventry Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 39.26, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "fee schedule", "standard_charge_dollar": 27.48, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Fairprice Healthcare Holdings", "plan_name": "Fairprice Healthcare Holdings", "methodology": "fee schedule", "standard_charge_dollar": 23.56, "additional_payer_notes": "Laboratory - 120.00% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ HMO POS", "methodology": "fee schedule", "standard_charge_dollar": 282.4, "additional_payer_notes": "177.30% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ Indemnity", "methodology": "fee schedule", "standard_charge_dollar": 282.4, "additional_payer_notes": "177.30% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ PPO", "methodology": "fee schedule", "standard_charge_dollar": 282.4, "additional_payer_notes": "177.30% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon Medicare", "methodology": "fee schedule", "standard_charge_dollar": 19.63, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Military Tricare", "methodology": "fee schedule", "standard_charge_dollar": 15.7, "additional_payer_notes": "80.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 19.63, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 19.63, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC All Payer (02-01-2023 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 11.78 }, { "payer_name": "UHC", "plan_name": "UHC Medicaid (02/01/2023 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 15.7 }, { "payer_name": "UHC", "plan_name": "UHC Oxford (02-01-2023 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 11.78 }, { "payer_name": "UHC - Adhoc", "plan_name": "UHC - Adhoc All Payer", "methodology": "fee schedule", "standard_charge_dollar": 19.63 }, { "payer_name": "UHC - Adhoc", "plan_name": "UHC - Adhoc Oxford", "methodology": "fee schedule", "standard_charge_dollar": 19.63 }, { "payer_name": "Wellcare", "plan_name": "Wellcare Insurance Exchange", "methodology": "fee schedule", "standard_charge_dollar": 26.5, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 19.63, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup Medicare", "methodology": "fee schedule", "standard_charge_dollar": 19.63, "additional_payer_notes": "100.00% of Medicare Rates" } ] } ] }, { "description": "ACUTE & SUBACUTE ENDOCARDITIS - SOI : 1", "code_information": [ { "code": "1931", "type": "APR-DRG" } ], "standard_charges": [ { "setting": "inpatient", "minimum": 9783.72, "maximum": 10762.09, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Better Health - Medi Medi", "methodology": "case rate", "standard_charge_dollar": 10762.09, "additional_payer_notes": "110% of State Medicaid Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Better Health Medicaid", "methodology": "case rate", "standard_charge_dollar": 10762.09, "additional_payer_notes": "110% of State Medicaid Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "case rate", "standard_charge_dollar": 9783.72, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "UBH", "plan_name": "UBH Medicaid", "methodology": "case rate", "standard_charge_dollar": 9783.72, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicaid (02/01/2023 to 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 9979.39, "additional_payer_notes": "102% of State Medicaid Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicaid", "methodology": "case rate", "standard_charge_dollar": 9783.72, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup Medicaid", "methodology": "case rate", "standard_charge_dollar": 9783.72, "additional_payer_notes": "100% of State Medicaid Rates" } ] } ] }, { "description": "Hc Egd Removal Tumor Polyp/Other Lesion Snare Tech", "code_information": [ { "code": "43251", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 7811.63, "discounted_cash": 2268.0, "minimum": 1491.2402, "maximum": 6639.8855, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 4809.3, "additional_payer_notes": "212.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medical Rental Network", "methodology": "fee schedule", "standard_charge_dollar": 4809.3, "additional_payer_notes": "212.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2268.54, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "ALLY-ALIGN (FKA SPARTAN PLAN NJ, INC.)", "plan_name": "ALLY-ALIGN (FKA SPARTAN PLAN NJ, INC.)", "methodology": "fee schedule", "standard_charge_dollar": 2381.97, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Americhoice (UHC)", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2268.54, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Amerihealth", "plan_name": "Amerihealth Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2268.54, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 3333.62, "additional_payer_notes": "146.95% of Medicare Rates" }, { "payer_name": "Clover Health", "plan_name": "Clover Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2268.54, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Coventry", "plan_name": "Coventry Auto", "methodology": "fee schedule", "standard_charge_dollar": 4537.08, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Coventry", "plan_name": "Coventry Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 4537.08, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "fee schedule", "standard_charge_dollar": 3175.96, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Fairprice Healthcare Holdings", "plan_name": "Fairprice Healthcare Holdings", "methodology": "fee schedule", "standard_charge_dollar": 3629.66, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ HMO POS", "methodology": "fee schedule", "standard_charge_dollar": 4022.12, "additional_payer_notes": "177.30% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ Indemnity", "methodology": "fee schedule", "standard_charge_dollar": 4022.12, "additional_payer_notes": "177.30% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ PPO", "methodology": "fee schedule", "standard_charge_dollar": 4022.12, "additional_payer_notes": "177.30% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2268.54, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon NJ Health Medicaid", "methodology": "percent of total billed charges", "standard_charge_percentage": 19.58, "median_amount": 1529.52, "10th_percentile": 1452.2, "90th_percentile": 1529.52, "count": "1 through 10" }, { "payer_name": "Humana", "plan_name": "Humana Military Tricare", "methodology": "fee schedule", "standard_charge_dollar": 1814.83, "additional_payer_notes": "80.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2268.54, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 2268.54, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC All Payer (02-01-2023 to 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 3912.0 }, { "payer_name": "UHC", "plan_name": "UHC Medicaid (02/01/2023 to 12-31-2026)", "methodology": "percent of total billed charges", "standard_charge_percentage": 19.47, "median_amount": 1486.01, "10th_percentile": 1486.01, "90th_percentile": 1486.01, "count": "1 through 10" }, { "payer_name": "UHC", "plan_name": "UHC Oxford (02-01-2023 to 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 3676.0 }, { "payer_name": "UHC - Adhoc", "plan_name": "UHC - Adhoc All Payer", "methodology": "case rate", "standard_charge_dollar": 4153.0 }, { "payer_name": "UHC - Adhoc", "plan_name": "UHC - Adhoc Oxford", "methodology": "case rate", "standard_charge_dollar": 3788.0 }, { "payer_name": "Wellcare", "plan_name": "Wellcare Insurance Exchange", "methodology": "fee schedule", "standard_charge_dollar": 3062.53, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2268.54, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2268.54, "additional_payer_notes": "100.00% of Medicare Rates" } ] } ] }, { "description": "Hc Thoracoscopy W/Parietal Pleurectomy", "code_information": [ { "code": "32656", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 1800.0, "minimum": 343.62, "maximum": 1800.0, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 690.38, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC All Payer (02-01-2023 to 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 1800.0 }, { "payer_name": "UHC", "plan_name": "UHC Oxford (02-01-2023 to 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 1800.0 }, { "payer_name": "UHC - Adhoc", "plan_name": "UHC - Adhoc All Payer", "methodology": "case rate", "standard_charge_dollar": 1800.0 }, { "payer_name": "UHC - Adhoc", "plan_name": "UHC - Adhoc Oxford", "methodology": "case rate", "standard_charge_dollar": 1800.0 }, { "payer_name": "Wellchoice", "plan_name": "WELLCHOICE HMO of NJ (Empire) Commercial (HMO / HMO POS, PPO)", "methodology": "case rate", "standard_charge_dollar": 1715.0 }, { "payer_name": "Wellchoice", "plan_name": "WELLCHOICE HMO of NJ (Empire) Commercial (Indemnity)", "methodology": "case rate", "standard_charge_dollar": 1800.0 } ] } ] }, { "description": "FRACTURES OF FEMUR WITHOUT MCC", "code_information": [ { "code": "534", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 10872.0, "minimum": 4842.48, "maximum": 19679.0259, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "case rate", "standard_charge_dollar": 19679.03, "additional_payer_notes": "181.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medical Rental Network", "methodology": "case rate", "standard_charge_dollar": 19679.03, "additional_payer_notes": "181.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "case rate", "standard_charge_dollar": 9036.95, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "ALLY-ALIGN (FKA SPARTAN PLAN NJ, INC.)", "plan_name": "ALLY-ALIGN (FKA SPARTAN PLAN NJ, INC.)", "methodology": "case rate", "standard_charge_dollar": 11416.01, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Americhoice (UHC)", "plan_name": "UHC Medicare", "methodology": "case rate", "standard_charge_dollar": 9036.95, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Amerihealth", "plan_name": "Amerihealth Medicare", "methodology": "case rate", "standard_charge_dollar": 9036.95, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Commercial", "methodology": "case rate", "standard_charge_dollar": 11793.24 }, { "payer_name": "Clover Health", "plan_name": "Clover Medicare", "methodology": "case rate", "standard_charge_dollar": 9036.95, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Coventry", "plan_name": "Coventry Auto", "methodology": "case rate", "standard_charge_dollar": 18483.06, "additional_payer_notes": "170.00% of Medicare Rates" }, { "payer_name": "Coventry", "plan_name": "Coventry Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 18483.06, "additional_payer_notes": "170.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "case rate", "standard_charge_dollar": 14134.11, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Fairprice Healthcare Holdings", "plan_name": "Fairprice Healthcare Holdings", "methodology": "case rate", "standard_charge_dollar": 17395.82, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon Medicare", "methodology": "case rate", "standard_charge_dollar": 9036.95, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon NJ Health Medicaid", "methodology": "case rate", "standard_charge_dollar": 4842.48 }, { "payer_name": "Humana", "plan_name": "Humana Military Tricare", "methodology": "case rate", "standard_charge_dollar": 8697.91, "additional_payer_notes": "80.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 10872.39, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 6805.21 }, { "payer_name": "UBH", "plan_name": "UBH Medicare", "methodology": "case rate", "standard_charge_dollar": 9036.95, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC All Payer (02-01-2023 to 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 13587.62 }, { "payer_name": "UHC", "plan_name": "UHC Oxford (02-01-2023 to 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 11841.61 }, { "payer_name": "UHC - Adhoc", "plan_name": "UHC - Adhoc All Payer", "methodology": "case rate", "standard_charge_dollar": 14423.55 }, { "payer_name": "UHC - Adhoc", "plan_name": "UHC - Adhoc Oxford", "methodology": "case rate", "standard_charge_dollar": 12202.74 }, { "payer_name": "Wellcare", "plan_name": "Wellcare Insurance Exchange", "methodology": "case rate", "standard_charge_dollar": 14677.73, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "case rate", "standard_charge_dollar": 9036.95, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup Medicare", "methodology": "case rate", "standard_charge_dollar": 9036.95, "additional_payer_notes": "100.00% of Medicare Rates" } ] } ] }, { "description": "O.R. PROCEDURES FOR OBESITY WITH CC", "code_information": [ { "code": "620", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 20050.0, "minimum": 11299.75, "maximum": 36291.4774, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "case rate", "standard_charge_dollar": 36291.48, "additional_payer_notes": "181.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medical Rental Network", "methodology": "case rate", "standard_charge_dollar": 36291.48, "additional_payer_notes": "181.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "case rate", "standard_charge_dollar": 16406.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "ALLY-ALIGN (FKA SPARTAN PLAN NJ, INC.)", "plan_name": "ALLY-ALIGN (FKA SPARTAN PLAN NJ, INC.)", "methodology": "case rate", "standard_charge_dollar": 21053.07, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Americhoice (UHC)", "plan_name": "UHC Medicare", "methodology": "case rate", "standard_charge_dollar": 16406.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Amerihealth", "plan_name": "Amerihealth Medicare", "methodology": "case rate", "standard_charge_dollar": 16406.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Commercial", "methodology": "case rate", "standard_charge_dollar": 23412.39 }, { "payer_name": "Clover Health", "plan_name": "Clover Medicare", "methodology": "case rate", "standard_charge_dollar": 16406.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Coventry", "plan_name": "Coventry Auto", "methodology": "case rate", "standard_charge_dollar": 34085.92, "additional_payer_notes": "170.00% of Medicare Rates" }, { "payer_name": "Coventry", "plan_name": "Coventry Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 34085.92, "additional_payer_notes": "170.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "case rate", "standard_charge_dollar": 26065.7, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Fairprice Healthcare Holdings", "plan_name": "Fairprice Healthcare Holdings", "methodology": "case rate", "standard_charge_dollar": 32080.86, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon Medicare", "methodology": "case rate", "standard_charge_dollar": 16406.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon NJ Health Medicaid", "methodology": "case rate", "standard_charge_dollar": 11299.75 }, { "payer_name": "Humana", "plan_name": "Humana Military Tricare", "methodology": "case rate", "standard_charge_dollar": 16040.43, "additional_payer_notes": "80.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 20050.54, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 22330.6 }, { "payer_name": "UBH", "plan_name": "UBH Medicare", "methodology": "case rate", "standard_charge_dollar": 16406.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC All Payer (02-01-2023 to 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 26974.66 }, { "payer_name": "UHC", "plan_name": "UHC Oxford (02-01-2023 to 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 23508.41 }, { "payer_name": "UHC - Adhoc", "plan_name": "UHC - Adhoc All Payer", "methodology": "case rate", "standard_charge_dollar": 28634.17 }, { "payer_name": "UHC - Adhoc", "plan_name": "UHC - Adhoc Oxford", "methodology": "case rate", "standard_charge_dollar": 24225.34 }, { "payer_name": "Wellcare", "plan_name": "Wellcare Insurance Exchange", "methodology": "case rate", "standard_charge_dollar": 27068.23, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "case rate", "standard_charge_dollar": 16406.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup Medicare", "methodology": "case rate", "standard_charge_dollar": 16406.8, "additional_payer_notes": "100.00% of Medicare Rates" } ] } ] }, { "description": "CARDIAC ARRHYTHMIA AND CONDUCTION DISORDERS WITHOUT CCMCC", "code_information": [ { "code": "310", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 8098.0, "minimum": 3511.19, "maximum": 14658.9004, "payers_information": [ { "payer_name": "Coventry", "plan_name": "Coventry Auto", "methodology": "case rate", "standard_charge_dollar": 13768.03, "additional_payer_notes": "170.00% of Medicare Rates" }, { "payer_name": "Coventry", "plan_name": "Coventry Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 13768.03, "additional_payer_notes": "170.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "case rate", "standard_charge_dollar": 10528.49, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Fairprice Healthcare Holdings", "plan_name": "Fairprice Healthcare Holdings", "methodology": "case rate", "standard_charge_dollar": 12958.14, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon Medicare", "methodology": "case rate", "standard_charge_dollar": 6809.86, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon NJ Health Medicaid", "methodology": "case rate", "standard_charge_dollar": 3511.19 }, { "payer_name": "Humana", "plan_name": "Humana Military Tricare", "methodology": "case rate", "standard_charge_dollar": 6479.07, "additional_payer_notes": "80.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 8098.84, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 5911.31 }, { "payer_name": "UBH", "plan_name": "UBH Medicare", "methodology": "case rate", "standard_charge_dollar": 6809.86, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC All Payer (02-01-2023 to 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 9542.18 }, { "payer_name": "UHC", "plan_name": "UHC Oxford (02-01-2023 to 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 8316.01 }, { "payer_name": "UHC - Adhoc", "plan_name": "UHC - Adhoc All Payer", "methodology": "case rate", "standard_charge_dollar": 10129.23 }, { "payer_name": "UHC - Adhoc", "plan_name": "UHC - Adhoc Oxford", "methodology": "case rate", "standard_charge_dollar": 8569.62 }, { "payer_name": "Wellcare", "plan_name": "Wellcare Insurance Exchange", "methodology": "case rate", "standard_charge_dollar": 10933.43, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "case rate", "standard_charge_dollar": 6809.86, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup Medicare", "methodology": "case rate", "standard_charge_dollar": 6809.86, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "case rate", "standard_charge_dollar": 14658.9, "additional_payer_notes": "181.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medical Rental Network", "methodology": "case rate", "standard_charge_dollar": 14658.9, "additional_payer_notes": "181.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "case rate", "standard_charge_dollar": 6809.86, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "ALLY-ALIGN (FKA SPARTAN PLAN NJ, INC.)", "plan_name": "ALLY-ALIGN (FKA SPARTAN PLAN NJ, INC.)", "methodology": "case rate", "standard_charge_dollar": 8503.78, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Americhoice (UHC)", "plan_name": "UHC Medicare", "methodology": "case rate", "standard_charge_dollar": 6809.86, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Amerihealth", "plan_name": "Amerihealth Medicare", "methodology": "case rate", "standard_charge_dollar": 6809.86, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Commercial", "methodology": "case rate", "standard_charge_dollar": 8282.04 }, { "payer_name": "Clover Health", "plan_name": "Clover Medicare", "methodology": "case rate", "standard_charge_dollar": 6809.86, "additional_payer_notes": "100.00% of Medicare Rates" } ] } ] }, { "description": "Perq lamot/lam crv/thrc", "code_information": [ { "code": "0274T", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 13674.0, "discounted_cash": 8578.0, "minimum": 1715.0, "maximum": 13674.0, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 13674.0, "additional_payer_notes": "212.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medical Rental Network", "methodology": "fee schedule", "standard_charge_dollar": 13674.0, "additional_payer_notes": "212.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 8578.33, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "ALLY-ALIGN (FKA SPARTAN PLAN NJ, INC.)", "plan_name": "ALLY-ALIGN (FKA SPARTAN PLAN NJ, INC.)", "methodology": "fee schedule", "standard_charge_dollar": 9007.25, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Americhoice (UHC)", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 8578.33, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Amerihealth", "plan_name": "Amerihealth Medicare", "methodology": "fee schedule", "standard_charge_dollar": 8578.33, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 12605.86, "additional_payer_notes": "146.95% of Medicare Rates" }, { "payer_name": "Clover Health", "plan_name": "Clover Medicare", "methodology": "fee schedule", "standard_charge_dollar": 8578.33, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Coventry", "plan_name": "Coventry Auto", "methodology": "fee schedule", "standard_charge_dollar": 13674.0, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Coventry", "plan_name": "Coventry Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 13674.0, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "fee schedule", "standard_charge_dollar": 12009.66, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Fairprice Healthcare Holdings", "plan_name": "Fairprice Healthcare Holdings", "methodology": "fee schedule", "standard_charge_dollar": 13674.0, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ HMO POS", "methodology": "fee schedule", "standard_charge_dollar": 13674.0, "additional_payer_notes": "177.30% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ Indemnity", "methodology": "fee schedule", "standard_charge_dollar": 13674.0, "additional_payer_notes": "177.30% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ PPO", "methodology": "fee schedule", "standard_charge_dollar": 13674.0, "additional_payer_notes": "177.30% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon Medicare", "methodology": "fee schedule", "standard_charge_dollar": 8578.33, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Military Tricare", "methodology": "fee schedule", "standard_charge_dollar": 6862.66, "additional_payer_notes": "80.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 8578.33, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 8578.33, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC All Payer (02-01-2023 to 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 6624.0 }, { "payer_name": "UHC", "plan_name": "UHC Oxford (02-01-2023 to 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 6317.0 }, { "payer_name": "UHC - Adhoc", "plan_name": "UHC - Adhoc All Payer", "methodology": "case rate", "standard_charge_dollar": 7031.0 }, { "payer_name": "UHC - Adhoc", "plan_name": "UHC - Adhoc Oxford", "methodology": "case rate", "standard_charge_dollar": 6510.0 }, { "payer_name": "Wellcare", "plan_name": "Wellcare Insurance Exchange", "methodology": "fee schedule", "standard_charge_dollar": 11580.75, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 8578.33, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellchoice", "plan_name": "WELLCHOICE HMO of NJ (Empire) Commercial (HMO / HMO POS, PPO)", "methodology": "case rate", "standard_charge_dollar": 1715.0 }, { "payer_name": "Wellchoice", "plan_name": "WELLCHOICE HMO of NJ (Empire) Commercial (Indemnity)", "methodology": "case rate", "standard_charge_dollar": 1978.0 }, { "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup Medicare", "methodology": "fee schedule", "standard_charge_dollar": 8578.33, "additional_payer_notes": "100.00% of Medicare Rates" } ] } ] }, { "description": "Hc Beta-2 Protein", "code_information": [ { "code": "82232", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 170.0, "discounted_cash": 16.0, "minimum": 9.71, "maximum": 144.5, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 34.3, "additional_payer_notes": "212.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medical Rental Network", "methodology": "fee schedule", "standard_charge_dollar": 34.3, "additional_payer_notes": "212.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 16.18, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "ALLY-ALIGN (FKA SPARTAN PLAN NJ, INC.)", "plan_name": "ALLY-ALIGN (FKA SPARTAN PLAN NJ, INC.)", "methodology": "fee schedule", "standard_charge_dollar": 16.99, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Americhoice (UHC)", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 16.18, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Amerihealth", "plan_name": "Amerihealth Medicare", "methodology": "fee schedule", "standard_charge_dollar": 16.18, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 23.46, "additional_payer_notes": "Laboratory - 145.00% of Medicare Rates" }, { "payer_name": "Clover Health", "plan_name": "Clover Medicare", "methodology": "fee schedule", "standard_charge_dollar": 16.18, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Coventry", "plan_name": "Coventry Auto", "methodology": "fee schedule", "standard_charge_dollar": 32.36, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Coventry", "plan_name": "Coventry Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 32.36, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "fee schedule", "standard_charge_dollar": 22.65, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Fairprice Healthcare Holdings", "plan_name": "Fairprice Healthcare Holdings", "methodology": "fee schedule", "standard_charge_dollar": 19.42, "additional_payer_notes": "Laboratory - 120.00% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ HMO POS", "methodology": "fee schedule", "standard_charge_dollar": 120.02, "additional_payer_notes": "177.30% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ Indemnity", "methodology": "fee schedule", "standard_charge_dollar": 120.02, "additional_payer_notes": "177.30% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ PPO", "methodology": "fee schedule", "standard_charge_dollar": 120.02, "additional_payer_notes": "177.30% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon Medicare", "methodology": "fee schedule", "standard_charge_dollar": 16.18, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Military Tricare", "methodology": "fee schedule", "standard_charge_dollar": 12.94, "additional_payer_notes": "80.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 16.18, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 16.18, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC All Payer (02-01-2023 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 9.71 }, { "payer_name": "UHC", "plan_name": "UHC Medicaid (02/01/2023 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 12.94 }, { "payer_name": "UHC", "plan_name": "UHC Oxford (02-01-2023 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 9.71 }, { "payer_name": "UHC - Adhoc", "plan_name": "UHC - Adhoc All Payer", "methodology": "fee schedule", "standard_charge_dollar": 16.18 }, { "payer_name": "UHC - Adhoc", "plan_name": "UHC - Adhoc Oxford", "methodology": "fee schedule", "standard_charge_dollar": 16.18 }, { "payer_name": "Wellcare", "plan_name": "Wellcare Insurance Exchange", "methodology": "fee schedule", "standard_charge_dollar": 21.84, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 16.18, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup Medicare", "methodology": "fee schedule", "standard_charge_dollar": 16.18, "additional_payer_notes": "100.00% of Medicare Rates" } ] } ] }, { "description": "Hc Strapping Of Ankle And/Or Ft", "code_information": [ { "code": "29540", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 668.7, "discounted_cash": 192.0, "minimum": 127.6548, "maximum": 668.7, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 407.25, "additional_payer_notes": "212.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medical Rental Network", "methodology": "fee schedule", "standard_charge_dollar": 407.25, "additional_payer_notes": "212.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 192.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "ALLY-ALIGN (FKA SPARTAN PLAN NJ, INC.)", "plan_name": "ALLY-ALIGN (FKA SPARTAN PLAN NJ, INC.)", "methodology": "fee schedule", "standard_charge_dollar": 201.71, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Americhoice (UHC)", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 192.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Amerihealth", "plan_name": "Amerihealth Medicare", "methodology": "fee schedule", "standard_charge_dollar": 192.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 282.29, "additional_payer_notes": "146.95% of Medicare Rates" }, { "payer_name": "Clover Health", "plan_name": "Clover Medicare", "methodology": "fee schedule", "standard_charge_dollar": 192.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Coventry", "plan_name": "Coventry Auto", "methodology": "fee schedule", "standard_charge_dollar": 384.2, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Coventry", "plan_name": "Coventry Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 384.2, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "fee schedule", "standard_charge_dollar": 268.94, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Fairprice Healthcare Holdings", "plan_name": "Fairprice Healthcare Holdings", "methodology": "fee schedule", "standard_charge_dollar": 307.36, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ HMO POS", "methodology": "fee schedule", "standard_charge_dollar": 340.59, "additional_payer_notes": "177.30% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ Indemnity", "methodology": "fee schedule", "standard_charge_dollar": 340.59, "additional_payer_notes": "177.30% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ PPO", "methodology": "fee schedule", "standard_charge_dollar": 340.59, "additional_payer_notes": "177.30% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon Medicare", "methodology": "fee schedule", "standard_charge_dollar": 192.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Military Tricare", "methodology": "fee schedule", "standard_charge_dollar": 153.68, "additional_payer_notes": "80.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 192.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 192.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC All Payer (02-01-2023 to 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 668.7 }, { "payer_name": "UHC", "plan_name": "UHC Oxford (02-01-2023 to 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 668.7 }, { "payer_name": "UHC - Adhoc", "plan_name": "UHC - Adhoc All Payer", "methodology": "case rate", "standard_charge_dollar": 668.7 }, { "payer_name": "UHC - Adhoc", "plan_name": "UHC - Adhoc Oxford", "methodology": "case rate", "standard_charge_dollar": 668.7 }, { "payer_name": "Wellcare", "plan_name": "Wellcare Insurance Exchange", "methodology": "fee schedule", "standard_charge_dollar": 259.34, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 192.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup Medicare", "methodology": "fee schedule", "standard_charge_dollar": 192.1, "additional_payer_notes": "100.00% of Medicare Rates" } ] } ] }, { "description": "PROSTATECTOMY WITH CC", "code_information": [ { "code": "666", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 21772.0, "minimum": 11109.3, "maximum": 39408.1345, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "case rate", "standard_charge_dollar": 39408.13, "additional_payer_notes": "181.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medical Rental Network", "methodology": "case rate", "standard_charge_dollar": 39408.13, "additional_payer_notes": "181.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "case rate", "standard_charge_dollar": 17789.4, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "ALLY-ALIGN (FKA SPARTAN PLAN NJ, INC.)", "plan_name": "ALLY-ALIGN (FKA SPARTAN PLAN NJ, INC.)", "methodology": "case rate", "standard_charge_dollar": 22861.07, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Americhoice (UHC)", "plan_name": "UHC Medicare", "methodology": "case rate", "standard_charge_dollar": 17789.4, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Amerihealth", "plan_name": "Amerihealth Medicare", "methodology": "case rate", "standard_charge_dollar": 17789.4, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Commercial", "methodology": "case rate", "standard_charge_dollar": 25592.26 }, { "payer_name": "Clover Health", "plan_name": "Clover Medicare", "methodology": "case rate", "standard_charge_dollar": 17789.4, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Coventry", "plan_name": "Coventry Auto", "methodology": "case rate", "standard_charge_dollar": 37013.17, "additional_payer_notes": "170.00% of Medicare Rates" }, { "payer_name": "Coventry", "plan_name": "Coventry Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 37013.17, "additional_payer_notes": "170.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "case rate", "standard_charge_dollar": 28304.19, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Fairprice Healthcare Holdings", "plan_name": "Fairprice Healthcare Holdings", "methodology": "case rate", "standard_charge_dollar": 34835.92, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon Medicare", "methodology": "case rate", "standard_charge_dollar": 17789.4, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon NJ Health Medicaid", "methodology": "case rate", "standard_charge_dollar": 11109.3 }, { "payer_name": "Humana", "plan_name": "Humana Military Tricare", "methodology": "case rate", "standard_charge_dollar": 17417.96, "additional_payer_notes": "80.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 21772.45, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 23966.3 }, { "payer_name": "UBH", "plan_name": "UBH Medicare", "methodology": "case rate", "standard_charge_dollar": 17789.4, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC All Payer (02-01-2023 to 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 29486.2 }, { "payer_name": "UHC", "plan_name": "UHC Oxford (02-01-2023 to 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 25697.22 }, { "payer_name": "UHC - Adhoc", "plan_name": "UHC - Adhoc All Payer", "methodology": "case rate", "standard_charge_dollar": 31300.22 }, { "payer_name": "UHC - Adhoc", "plan_name": "UHC - Adhoc Oxford", "methodology": "case rate", "standard_charge_dollar": 26480.9 }, { "payer_name": "Wellcare", "plan_name": "Wellcare Insurance Exchange", "methodology": "case rate", "standard_charge_dollar": 29392.81, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "case rate", "standard_charge_dollar": 17789.4, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup Medicare", "methodology": "case rate", "standard_charge_dollar": 17789.4, "additional_payer_notes": "100.00% of Medicare Rates" } ] } ] }, { "description": "Hc Dcmprn Px Perq 1/Mlt Lumbar", "code_information": [ { "code": "62287", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 9198.15, "discounted_cash": 2308.0, "minimum": 1715.0, "maximum": 12312.0, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 4894.04, "additional_payer_notes": "212.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medical Rental Network", "methodology": "fee schedule", "standard_charge_dollar": 4894.04, "additional_payer_notes": "212.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2308.51, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "ALLY-ALIGN (FKA SPARTAN PLAN NJ, INC.)", "plan_name": "ALLY-ALIGN (FKA SPARTAN PLAN NJ, INC.)", "methodology": "fee schedule", "standard_charge_dollar": 2423.94, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Americhoice (UHC)", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2308.51, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Amerihealth", "plan_name": "Amerihealth Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2308.51, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 3392.36, "additional_payer_notes": "146.95% of Medicare Rates" }, { "payer_name": "Clover Health", "plan_name": "Clover Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2308.51, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Coventry", "plan_name": "Coventry Auto", "methodology": "fee schedule", "standard_charge_dollar": 4617.02, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Coventry", "plan_name": "Coventry Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 4617.02, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "fee schedule", "standard_charge_dollar": 3231.91, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Fairprice Healthcare Holdings", "plan_name": "Fairprice Healthcare Holdings", "methodology": "fee schedule", "standard_charge_dollar": 3693.62, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ HMO POS", "methodology": "fee schedule", "standard_charge_dollar": 4092.99, "additional_payer_notes": "177.30% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ Indemnity", "methodology": "fee schedule", "standard_charge_dollar": 4092.99, "additional_payer_notes": "177.30% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ PPO", "methodology": "fee schedule", "standard_charge_dollar": 4092.99, "additional_payer_notes": "177.30% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2308.51, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Military Tricare", "methodology": "fee schedule", "standard_charge_dollar": 1846.81, "additional_payer_notes": "80.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2308.51, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 2308.51, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC All Payer (02-01-2023 to 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 5378.0 }, { "payer_name": "UHC", "plan_name": "UHC Oxford (02-01-2023 to 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 5169.0 }, { "payer_name": "UHC - Adhoc", "plan_name": "UHC - Adhoc All Payer", "methodology": "case rate", "standard_charge_dollar": 5709.0 }, { "payer_name": "UHC - Adhoc", "plan_name": "UHC - Adhoc Oxford", "methodology": "case rate", "standard_charge_dollar": 5327.0 }, { "payer_name": "Wellcare", "plan_name": "Wellcare Insurance Exchange", "methodology": "fee schedule", "standard_charge_dollar": 3116.49, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2308.51, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellchoice", "plan_name": "WELLCHOICE HMO of NJ (Empire) Commercial (HMO / HMO POS, PPO)", "methodology": "case rate", "standard_charge_dollar": 1715.0 }, { "payer_name": "Wellchoice", "plan_name": "WELLCHOICE HMO of NJ (Empire) Commercial (Indemnity)", "methodology": "case rate", "standard_charge_dollar": 1978.0 }, { "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2308.51, "additional_payer_notes": "100.00% of Medicare Rates" } ] } ] }, { "description": "DIGESTIVE MALIGNANCY WITH MCC", "code_information": [ { "code": "374", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 26272.0, "minimum": 12894.55, "maximum": 47553.2974, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "case rate", "standard_charge_dollar": 47553.3, "additional_payer_notes": "181.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medical Rental Network", "methodology": "case rate", "standard_charge_dollar": 47553.3, "additional_payer_notes": "181.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "case rate", "standard_charge_dollar": 21402.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "ALLY-ALIGN (FKA SPARTAN PLAN NJ, INC.)", "plan_name": "ALLY-ALIGN (FKA SPARTAN PLAN NJ, INC.)", "methodology": "case rate", "standard_charge_dollar": 27586.17, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Americhoice (UHC)", "plan_name": "UHC Medicare", "methodology": "case rate", "standard_charge_dollar": 21402.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Amerihealth", "plan_name": "Amerihealth Medicare", "methodology": "case rate", "standard_charge_dollar": 21402.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Commercial", "methodology": "case rate", "standard_charge_dollar": 31289.18 }, { "payer_name": "Clover Health", "plan_name": "Clover Medicare", "methodology": "case rate", "standard_charge_dollar": 21402.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Coventry", "plan_name": "Coventry Auto", "methodology": "case rate", "standard_charge_dollar": 44663.32, "additional_payer_notes": "170.00% of Medicare Rates" }, { "payer_name": "Coventry", "plan_name": "Coventry Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 44663.32, "additional_payer_notes": "170.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "case rate", "standard_charge_dollar": 34154.3, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Fairprice Healthcare Holdings", "plan_name": "Fairprice Healthcare Holdings", "methodology": "case rate", "standard_charge_dollar": 42036.06, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon Medicare", "methodology": "case rate", "standard_charge_dollar": 21402.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon NJ Health Medicaid", "methodology": "case rate", "standard_charge_dollar": 12894.55 }, { "payer_name": "Humana", "plan_name": "Humana Military Tricare", "methodology": "case rate", "standard_charge_dollar": 21018.03, "additional_payer_notes": "80.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 26272.54, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 28479.1 }, { "payer_name": "UBH", "plan_name": "UBH Medicare", "methodology": "case rate", "standard_charge_dollar": 21402.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC All Payer (02-01-2023 to 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 36049.93 }, { "payer_name": "UHC", "plan_name": "UHC Oxford (02-01-2023 to 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 31417.5 }, { "payer_name": "UHC - Adhoc", "plan_name": "UHC - Adhoc All Payer", "methodology": "case rate", "standard_charge_dollar": 38267.76 }, { "payer_name": "UHC - Adhoc", "plan_name": "UHC - Adhoc Oxford", "methodology": "case rate", "standard_charge_dollar": 32375.64 }, { "payer_name": "Wellcare", "plan_name": "Wellcare Insurance Exchange", "methodology": "case rate", "standard_charge_dollar": 35467.93, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "case rate", "standard_charge_dollar": 21402.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup Medicare", "methodology": "case rate", "standard_charge_dollar": 21402.8, "additional_payer_notes": "100.00% of Medicare Rates" } ] } ] }, { "description": "INJ PLSM IMGE GUIDE HRVST/PR", "code_information": [ { "code": "0232T", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 27491.0, "discounted_cash": 528.0, "minimum": 422.496, "maximum": 21992.8, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 1119.61, "additional_payer_notes": "212.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medical Rental Network", "methodology": "fee schedule", "standard_charge_dollar": 1119.61, "additional_payer_notes": "212.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 528.12, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "ALLY-ALIGN (FKA SPARTAN PLAN NJ, INC.)", "plan_name": "ALLY-ALIGN (FKA SPARTAN PLAN NJ, INC.)", "methodology": "fee schedule", "standard_charge_dollar": 554.53, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Americhoice (UHC)", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 528.12, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Amerihealth", "plan_name": "Amerihealth Medicare", "methodology": "fee schedule", "standard_charge_dollar": 528.12, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 776.07, "additional_payer_notes": "146.95% of Medicare Rates" }, { "payer_name": "Clover Health", "plan_name": "Clover Medicare", "methodology": "fee schedule", "standard_charge_dollar": 528.12, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Coventry", "plan_name": "Coventry Auto", "methodology": "fee schedule", "standard_charge_dollar": 1056.24, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Coventry", "plan_name": "Coventry Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 1056.24, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "fee schedule", "standard_charge_dollar": 739.37, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Fairprice Healthcare Holdings", "plan_name": "Fairprice Healthcare Holdings", "methodology": "fee schedule", "standard_charge_dollar": 844.99, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ HMO POS", "methodology": "fee schedule", "standard_charge_dollar": 936.36, "additional_payer_notes": "177.30% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ Indemnity", "methodology": "fee schedule", "standard_charge_dollar": 936.36, "additional_payer_notes": "177.30% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ PPO", "methodology": "fee schedule", "standard_charge_dollar": 936.36, "additional_payer_notes": "177.30% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon Medicare", "methodology": "fee schedule", "standard_charge_dollar": 528.12, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Military Tricare", "methodology": "fee schedule", "standard_charge_dollar": 422.5, "additional_payer_notes": "80.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 528.12, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 528.12, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC All Payer (02-01-2023 to 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 3057.0 }, { "payer_name": "UHC", "plan_name": "UHC Oxford (02-01-2023 to 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 2297.0 }, { "payer_name": "UHC - Adhoc", "plan_name": "UHC - Adhoc All Payer", "methodology": "case rate", "standard_charge_dollar": 3245.0 }, { "payer_name": "UHC - Adhoc", "plan_name": "UHC - Adhoc Oxford", "methodology": "case rate", "standard_charge_dollar": 2367.0 }, { "payer_name": "Wellcare", "plan_name": "Wellcare Insurance Exchange", "methodology": "fee schedule", "standard_charge_dollar": 712.96, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 528.12, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellchoice", "plan_name": "WELLCHOICE HMO of NJ (Empire) Commercial (HMO / HMO POS, PPO)", "methodology": "case rate", "standard_charge_dollar": 1715.0 }, { "payer_name": "Wellchoice", "plan_name": "WELLCHOICE HMO of NJ (Empire) Commercial (Indemnity)", "methodology": "case rate", "standard_charge_dollar": 1978.0 }, { "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup Medicare", "methodology": "fee schedule", "standard_charge_dollar": 528.12, "additional_payer_notes": "100.00% of Medicare Rates" } ] } ] }, { "description": "TENDON, MUSCLE & OTHER SOFT TISSUE PROCEDURES - SOI : 4", "code_information": [ { "code": "3174", "type": "APR-DRG" } ], "standard_charges": [ { "setting": "inpatient", "minimum": 42605.0, "maximum": 46865.5, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Better Health - Medi Medi", "methodology": "case rate", "standard_charge_dollar": 46865.5, "additional_payer_notes": "110% of State Medicaid Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Better Health Medicaid", "methodology": "case rate", "standard_charge_dollar": 46865.5, "additional_payer_notes": "110% of State Medicaid Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "case rate", "standard_charge_dollar": 42605.0, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "UBH", "plan_name": "UBH Medicaid", "methodology": "case rate", "standard_charge_dollar": 42605.0, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicaid (02/01/2023 to 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 43457.1, "additional_payer_notes": "102% of State Medicaid Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicaid", "methodology": "case rate", "standard_charge_dollar": 42605.0, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup Medicaid", "methodology": "case rate", "standard_charge_dollar": 42605.0, "additional_payer_notes": "100% of State Medicaid Rates" } ] } ] }, { "description": "Hc Fibrin Degradproducts,D-Dimer, Qual", "code_information": [ { "code": "85378", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 180.0, "discounted_cash": 9.0, "minimum": 5.83, "maximum": 153.0, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 20.61, "additional_payer_notes": "212.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medical Rental Network", "methodology": "fee schedule", "standard_charge_dollar": 20.61, "additional_payer_notes": "212.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 9.72, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "ALLY-ALIGN (FKA SPARTAN PLAN NJ, INC.)", "plan_name": "ALLY-ALIGN (FKA SPARTAN PLAN NJ, INC.)", "methodology": "fee schedule", "standard_charge_dollar": 10.21, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Americhoice (UHC)", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 9.72, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Amerihealth", "plan_name": "Amerihealth Medicare", "methodology": "fee schedule", "standard_charge_dollar": 9.72, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 14.09, "additional_payer_notes": "Laboratory - 145.00% of Medicare Rates" }, { "payer_name": "Clover Health", "plan_name": "Clover Medicare", "methodology": "fee schedule", "standard_charge_dollar": 9.72, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Coventry", "plan_name": "Coventry Auto", "methodology": "fee schedule", "standard_charge_dollar": 19.44, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Coventry", "plan_name": "Coventry Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 19.44, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "fee schedule", "standard_charge_dollar": 13.61, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Fairprice Healthcare Holdings", "plan_name": "Fairprice Healthcare Holdings", "methodology": "fee schedule", "standard_charge_dollar": 11.66, "additional_payer_notes": "Laboratory - 120.00% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ HMO POS", "methodology": "fee schedule", "standard_charge_dollar": 127.08, "additional_payer_notes": "177.30% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ Indemnity", "methodology": "fee schedule", "standard_charge_dollar": 127.08, "additional_payer_notes": "177.30% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ PPO", "methodology": "fee schedule", "standard_charge_dollar": 127.08, "additional_payer_notes": "177.30% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon Medicare", "methodology": "fee schedule", "standard_charge_dollar": 9.72, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Military Tricare", "methodology": "fee schedule", "standard_charge_dollar": 7.78, "additional_payer_notes": "80.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 9.72, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 9.72, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC All Payer (02-01-2023 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 5.83 }, { "payer_name": "UHC", "plan_name": "UHC Medicaid (02/01/2023 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 7.78 }, { "payer_name": "UHC", "plan_name": "UHC Oxford (02-01-2023 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 5.83 }, { "payer_name": "UHC - Adhoc", "plan_name": "UHC - Adhoc All Payer", "methodology": "fee schedule", "standard_charge_dollar": 9.72 }, { "payer_name": "UHC - Adhoc", "plan_name": "UHC - Adhoc Oxford", "methodology": "fee schedule", "standard_charge_dollar": 9.72 }, { "payer_name": "Wellcare", "plan_name": "Wellcare Insurance Exchange", "methodology": "fee schedule", "standard_charge_dollar": 13.12, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 9.72, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup Medicare", "methodology": "fee schedule", "standard_charge_dollar": 9.72, "additional_payer_notes": "100.00% of Medicare Rates" } ] } ] }, { "description": "Hc Platelets Pheresis Leukocytes Reduced, Per Unit", "code_information": [ { "code": "P9035", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 3230.09, "discounted_cash": 509.0, "minimum": 407.264, "maximum": 2584.072, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 1079.25, "additional_payer_notes": "212.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medical Rental Network", "methodology": "fee schedule", "standard_charge_dollar": 1079.25, "additional_payer_notes": "212.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 509.08, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "ALLY-ALIGN (FKA SPARTAN PLAN NJ, INC.)", "plan_name": "ALLY-ALIGN (FKA SPARTAN PLAN NJ, INC.)", "methodology": "fee schedule", "standard_charge_dollar": 534.53, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Americhoice (UHC)", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 509.08, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Amerihealth", "plan_name": "Amerihealth Medicare", "methodology": "fee schedule", "standard_charge_dollar": 509.08, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 748.09, "additional_payer_notes": "146.95% of Medicare Rates" }, { "payer_name": "Clover Health", "plan_name": "Clover Medicare", "methodology": "fee schedule", "standard_charge_dollar": 509.08, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Coventry", "plan_name": "Coventry Auto", "methodology": "fee schedule", "standard_charge_dollar": 1018.16, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Coventry", "plan_name": "Coventry Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 1018.16, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "fee schedule", "standard_charge_dollar": 712.71, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Fairprice Healthcare Holdings", "plan_name": "Fairprice Healthcare Holdings", "methodology": "fee schedule", "standard_charge_dollar": 814.53, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ HMO POS", "methodology": "fee schedule", "standard_charge_dollar": 902.6, "additional_payer_notes": "177.30% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ Indemnity", "methodology": "fee schedule", "standard_charge_dollar": 902.6, "additional_payer_notes": "177.30% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ PPO", "methodology": "fee schedule", "standard_charge_dollar": 902.6, "additional_payer_notes": "177.30% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon Medicare", "methodology": "fee schedule", "standard_charge_dollar": 509.08, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Military Tricare", "methodology": "fee schedule", "standard_charge_dollar": 407.26, "additional_payer_notes": "80.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 509.08, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 509.08, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Insurance Exchange", "methodology": "fee schedule", "standard_charge_dollar": 687.26, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 509.08, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup Medicare", "methodology": "fee schedule", "standard_charge_dollar": 509.08, "additional_payer_notes": "100.00% of Medicare Rates" } ] } ] }, { "description": "Hc Arc Blood Typing, Rh Phenotype", "code_information": [ { "code": "86906", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 79.0, "discounted_cash": 44.0, "minimum": 4.65, "maximum": 79.0, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 79.0, "additional_payer_notes": "212.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medical Rental Network", "methodology": "fee schedule", "standard_charge_dollar": 79.0, "additional_payer_notes": "212.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 44.15, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "ALLY-ALIGN (FKA SPARTAN PLAN NJ, INC.)", "plan_name": "ALLY-ALIGN (FKA SPARTAN PLAN NJ, INC.)", "methodology": "fee schedule", "standard_charge_dollar": 46.36, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Americhoice (UHC)", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 44.15, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Amerihealth", "plan_name": "Amerihealth Medicare", "methodology": "fee schedule", "standard_charge_dollar": 44.15, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 64.88, "additional_payer_notes": "Laboratory - 145.00% of Medicare Rates" }, { "payer_name": "Clover Health", "plan_name": "Clover Medicare", "methodology": "fee schedule", "standard_charge_dollar": 44.15, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Coventry", "plan_name": "Coventry Auto", "methodology": "fee schedule", "standard_charge_dollar": 79.0, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Coventry", "plan_name": "Coventry Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 79.0, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "fee schedule", "standard_charge_dollar": 61.81, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Fairprice Healthcare Holdings", "plan_name": "Fairprice Healthcare Holdings", "methodology": "fee schedule", "standard_charge_dollar": 70.64, "additional_payer_notes": "Laboratory - 120.00% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ HMO POS", "methodology": "fee schedule", "standard_charge_dollar": 78.28, "additional_payer_notes": "177.30% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ Indemnity", "methodology": "fee schedule", "standard_charge_dollar": 78.28, "additional_payer_notes": "177.30% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ PPO", "methodology": "fee schedule", "standard_charge_dollar": 78.28, "additional_payer_notes": "177.30% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon Medicare", "methodology": "fee schedule", "standard_charge_dollar": 44.15, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Military Tricare", "methodology": "fee schedule", "standard_charge_dollar": 35.32, "additional_payer_notes": "80.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 44.15, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 44.15, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC All Payer (02-01-2023 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 4.65 }, { "payer_name": "UHC", "plan_name": "UHC Medicaid (02/01/2023 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 6.2 }, { "payer_name": "UHC", "plan_name": "UHC Oxford (02-01-2023 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 4.65 }, { "payer_name": "UHC - Adhoc", "plan_name": "UHC - Adhoc All Payer", "methodology": "fee schedule", "standard_charge_dollar": 7.75 }, { "payer_name": "UHC - Adhoc", "plan_name": "UHC - Adhoc Oxford", "methodology": "fee schedule", "standard_charge_dollar": 7.75 }, { "payer_name": "Wellcare", "plan_name": "Wellcare Insurance Exchange", "methodology": "fee schedule", "standard_charge_dollar": 59.6, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 44.15, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup Medicare", "methodology": "fee schedule", "standard_charge_dollar": 44.15, "additional_payer_notes": "100.00% of Medicare Rates" } ] } ] }, { "description": "MAJOR PANCREAS, LIVER & SHUNT PROCEDURES - SOI : 2", "code_information": [ { "code": "2602", "type": "APR-DRG" } ], "standard_charges": [ { "setting": "inpatient", "minimum": 28193.69, "maximum": 31013.06, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Better Health - Medi Medi", "methodology": "case rate", "standard_charge_dollar": 31013.06, "additional_payer_notes": "110% of State Medicaid Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Better Health Medicaid", "methodology": "case rate", "standard_charge_dollar": 31013.06, "additional_payer_notes": "110% of State Medicaid Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "case rate", "standard_charge_dollar": 28193.69, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "UBH", "plan_name": "UBH Medicaid", "methodology": "case rate", "standard_charge_dollar": 28193.69, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicaid (02/01/2023 to 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 28757.56, "additional_payer_notes": "102% of State Medicaid Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicaid", "methodology": "case rate", "standard_charge_dollar": 28193.69, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup Medicaid", "methodology": "case rate", "standard_charge_dollar": 28193.69, "additional_payer_notes": "100% of State Medicaid Rates" } ] } ] }, { "description": "ALCOHOL & DRUG DEPENDENCE W REHAB OR REHABDETOX THERAPY - SOI : 1", "code_information": [ { "code": "7721", "type": "APR-DRG" } ], "standard_charges": [ { "setting": "inpatient", "minimum": 5832.84, "maximum": 6416.12, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Better Health - Medi Medi", "methodology": "case rate", "standard_charge_dollar": 6416.12, "additional_payer_notes": "110% of State Medicaid Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Better Health Medicaid", "methodology": "case rate", "standard_charge_dollar": 6416.12, "additional_payer_notes": "110% of State Medicaid Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "case rate", "standard_charge_dollar": 5832.84, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "UBH", "plan_name": "UBH Medicaid", "methodology": "case rate", "standard_charge_dollar": 5832.84, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicaid (02/01/2023 to 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 5949.5, "additional_payer_notes": "102% of State Medicaid Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicaid", "methodology": "case rate", "standard_charge_dollar": 5832.84, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup Medicaid", "methodology": "case rate", "standard_charge_dollar": 5832.84, "additional_payer_notes": "100% of State Medicaid Rates" } ] } ] }, { "description": "Hc Tumor Immunohistochem/Manual", "code_information": [ { "code": "88360", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 701.2, "discounted_cash": 201.0, "minimum": 86.1, "maximum": 596.02, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 426.99, "additional_payer_notes": "212.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medical Rental Network", "methodology": "fee schedule", "standard_charge_dollar": 426.99, "additional_payer_notes": "212.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 201.41, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "ALLY-ALIGN (FKA SPARTAN PLAN NJ, INC.)", "plan_name": "ALLY-ALIGN (FKA SPARTAN PLAN NJ, INC.)", "methodology": "fee schedule", "standard_charge_dollar": 211.48, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Americhoice (UHC)", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 201.41, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Amerihealth", "plan_name": "Amerihealth Medicare", "methodology": "fee schedule", "standard_charge_dollar": 201.41, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 295.97, "additional_payer_notes": "146.95% of Medicare Rates" }, { "payer_name": "Clover Health", "plan_name": "Clover Medicare", "methodology": "fee schedule", "standard_charge_dollar": 201.41, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Coventry", "plan_name": "Coventry Auto", "methodology": "fee schedule", "standard_charge_dollar": 402.82, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Coventry", "plan_name": "Coventry Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 402.82, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "fee schedule", "standard_charge_dollar": 281.97, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Fairprice Healthcare Holdings", "plan_name": "Fairprice Healthcare Holdings", "methodology": "fee schedule", "standard_charge_dollar": 322.26, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ HMO POS", "methodology": "fee schedule", "standard_charge_dollar": 357.1, "additional_payer_notes": "177.30% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ Indemnity", "methodology": "fee schedule", "standard_charge_dollar": 357.1, "additional_payer_notes": "177.30% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ PPO", "methodology": "fee schedule", "standard_charge_dollar": 357.1, "additional_payer_notes": "177.30% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon Medicare", "methodology": "fee schedule", "standard_charge_dollar": 201.41, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon NJ Health Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 97.98 }, { "payer_name": "Humana", "plan_name": "Humana Military Tricare", "methodology": "fee schedule", "standard_charge_dollar": 161.13, "additional_payer_notes": "80.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 201.41, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 201.41, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC All Payer (02-01-2023 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 86.1 }, { "payer_name": "UHC", "plan_name": "UHC Medicaid (02/01/2023 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 97.98 }, { "payer_name": "UHC", "plan_name": "UHC Oxford (02-01-2023 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 86.1 }, { "payer_name": "UHC - Adhoc", "plan_name": "UHC - Adhoc All Payer", "methodology": "fee schedule", "standard_charge_dollar": 143.5 }, { "payer_name": "UHC - Adhoc", "plan_name": "UHC - Adhoc Oxford", "methodology": "fee schedule", "standard_charge_dollar": 143.5 }, { "payer_name": "Wellcare", "plan_name": "Wellcare Insurance Exchange", "methodology": "fee schedule", "standard_charge_dollar": 271.9, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 201.41, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup Medicare", "methodology": "fee schedule", "standard_charge_dollar": 201.41, "additional_payer_notes": "100.00% of Medicare Rates" } ] } ] }, { "description": "TRAUMATIC STUPOR AND COMA >1 HOUR WITH MCC", "code_information": [ { "code": "082", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 27970.0, "minimum": 13479.02, "maximum": 50626.0439, "payers_information": [ { "payer_name": "Cigna", "plan_name": "Cigna Commercial", "methodology": "case rate", "standard_charge_dollar": 33438.33 }, { "payer_name": "Clover Health", "plan_name": "Clover Medicare", "methodology": "case rate", "standard_charge_dollar": 22766.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Coventry", "plan_name": "Coventry Auto", "methodology": "case rate", "standard_charge_dollar": 47549.32, "additional_payer_notes": "170.00% of Medicare Rates" }, { "payer_name": "Coventry", "plan_name": "Coventry Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 47549.32, "additional_payer_notes": "170.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "case rate", "standard_charge_dollar": 36361.25, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Fairprice Healthcare Holdings", "plan_name": "Fairprice Healthcare Holdings", "methodology": "case rate", "standard_charge_dollar": 44752.3, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon Medicare", "methodology": "case rate", "standard_charge_dollar": 22766.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon NJ Health Medicaid", "methodology": "case rate", "standard_charge_dollar": 13479.02 }, { "payer_name": "Humana", "plan_name": "Humana Military Tricare", "methodology": "case rate", "standard_charge_dollar": 22376.15, "additional_payer_notes": "80.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 27970.19, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 23743.5 }, { "payer_name": "UBH", "plan_name": "UBH Medicare", "methodology": "case rate", "standard_charge_dollar": 22766.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC All Payer (02-01-2023 to 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 38526.07 }, { "payer_name": "UHC", "plan_name": "UHC Oxford (02-01-2023 to 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 33575.46 }, { "payer_name": "UHC - Adhoc", "plan_name": "UHC - Adhoc All Payer", "methodology": "case rate", "standard_charge_dollar": 40896.24 }, { "payer_name": "UHC - Adhoc", "plan_name": "UHC - Adhoc Oxford", "methodology": "case rate", "standard_charge_dollar": 34599.41 }, { "payer_name": "Wellcare", "plan_name": "Wellcare Insurance Exchange", "methodology": "case rate", "standard_charge_dollar": 37759.76, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "case rate", "standard_charge_dollar": 22766.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup Medicare", "methodology": "case rate", "standard_charge_dollar": 22766.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "case rate", "standard_charge_dollar": 50626.04, "additional_payer_notes": "181.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medical Rental Network", "methodology": "case rate", "standard_charge_dollar": 50626.04, "additional_payer_notes": "181.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "case rate", "standard_charge_dollar": 22766.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "ALLY-ALIGN (FKA SPARTAN PLAN NJ, INC.)", "plan_name": "ALLY-ALIGN (FKA SPARTAN PLAN NJ, INC.)", "methodology": "case rate", "standard_charge_dollar": 29368.7, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Americhoice (UHC)", "plan_name": "UHC Medicare", "methodology": "case rate", "standard_charge_dollar": 22766.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Amerihealth", "plan_name": "Amerihealth Medicare", "methodology": "case rate", "standard_charge_dollar": 22766.0, "additional_payer_notes": "100.00% of Medicare Rates" } ] } ] }, { "description": "Hc Trlml Blln Angiop Open/Perq Img S&I Init Art", "code_information": [ { "code": "37246", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 23392.7, "discounted_cash": 6728.0, "minimum": 2472.0, "maximum": 18714.16, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 14264.61, "additional_payer_notes": "212.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medical Rental Network", "methodology": "fee schedule", "standard_charge_dollar": 14264.61, "additional_payer_notes": "212.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 6728.59, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "ALLY-ALIGN (FKA SPARTAN PLAN NJ, INC.)", "plan_name": "ALLY-ALIGN (FKA SPARTAN PLAN NJ, INC.)", "methodology": "fee schedule", "standard_charge_dollar": 7065.02, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Americhoice (UHC)", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 6728.59, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Amerihealth", "plan_name": "Amerihealth Medicare", "methodology": "fee schedule", "standard_charge_dollar": 6728.59, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 9887.66, "additional_payer_notes": "146.95% of Medicare Rates" }, { "payer_name": "Clover Health", "plan_name": "Clover Medicare", "methodology": "fee schedule", "standard_charge_dollar": 6728.59, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Coventry", "plan_name": "Coventry Auto", "methodology": "fee schedule", "standard_charge_dollar": 13457.18, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Coventry", "plan_name": "Coventry Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 13457.18, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "fee schedule", "standard_charge_dollar": 9420.03, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Fairprice Healthcare Holdings", "plan_name": "Fairprice Healthcare Holdings", "methodology": "fee schedule", "standard_charge_dollar": 10765.74, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ HMO POS", "methodology": "fee schedule", "standard_charge_dollar": 11929.79, "additional_payer_notes": "177.30% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ Indemnity", "methodology": "fee schedule", "standard_charge_dollar": 11929.79, "additional_payer_notes": "177.30% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ PPO", "methodology": "fee schedule", "standard_charge_dollar": 11929.79, "additional_payer_notes": "177.30% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon Medicare", "methodology": "fee schedule", "standard_charge_dollar": 6728.59, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Military Tricare", "methodology": "fee schedule", "standard_charge_dollar": 5382.87, "additional_payer_notes": "80.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 6728.59, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 6728.59, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC All Payer (02-01-2023 to 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 6624.0 }, { "payer_name": "UHC", "plan_name": "UHC Oxford (02-01-2023 to 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 6317.0 }, { "payer_name": "UHC - Adhoc", "plan_name": "UHC - Adhoc All Payer", "methodology": "case rate", "standard_charge_dollar": 7031.0 }, { "payer_name": "UHC - Adhoc", "plan_name": "UHC - Adhoc Oxford", "methodology": "case rate", "standard_charge_dollar": 6510.0 }, { "payer_name": "Wellcare", "plan_name": "Wellcare Insurance Exchange", "methodology": "fee schedule", "standard_charge_dollar": 9083.6, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 6728.59, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellchoice", "plan_name": "WELLCHOICE HMO of NJ (Empire) Commercial (HMO / HMO POS, PPO)", "methodology": "case rate", "standard_charge_dollar": 2472.0 }, { "payer_name": "Wellchoice", "plan_name": "WELLCHOICE HMO of NJ (Empire) Commercial (Indemnity)", "methodology": "case rate", "standard_charge_dollar": 2753.0 }, { "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup Medicare", "methodology": "fee schedule", "standard_charge_dollar": 6728.59, "additional_payer_notes": "100.00% of Medicare Rates" } ] } ] }, { "description": "FRACTURE OF PELVIS OR DISLOCATION OF HIP - SOI : 3", "code_information": [ { "code": "3413", "type": "APR-DRG" } ], "standard_charges": [ { "setting": "inpatient", "minimum": 10171.72, "maximum": 11188.9, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Better Health - Medi Medi", "methodology": "case rate", "standard_charge_dollar": 11188.9, "additional_payer_notes": "110% of State Medicaid Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Better Health Medicaid", "methodology": "case rate", "standard_charge_dollar": 11188.9, "additional_payer_notes": "110% of State Medicaid Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "case rate", "standard_charge_dollar": 10171.72, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "UBH", "plan_name": "UBH Medicaid", "methodology": "case rate", "standard_charge_dollar": 10171.72, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicaid (02/01/2023 to 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 10375.16, "additional_payer_notes": "102% of State Medicaid Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicaid", "methodology": "case rate", "standard_charge_dollar": 10171.72, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup Medicaid", "methodology": "case rate", "standard_charge_dollar": 10171.72, "additional_payer_notes": "100% of State Medicaid Rates" } ] } ] }, { "description": "Hc Clostridium Ag, Eia", "code_information": [ { "code": "87324", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 102.0, "discounted_cash": 11.0, "minimum": 7.19, "maximum": 86.7, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 25.4, "additional_payer_notes": "212.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medical Rental Network", "methodology": "fee schedule", "standard_charge_dollar": 25.4, "additional_payer_notes": "212.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 11.98, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "ALLY-ALIGN (FKA SPARTAN PLAN NJ, INC.)", "plan_name": "ALLY-ALIGN (FKA SPARTAN PLAN NJ, INC.)", "methodology": "fee schedule", "standard_charge_dollar": 12.58, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Americhoice (UHC)", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 11.98, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Amerihealth", "plan_name": "Amerihealth Medicare", "methodology": "fee schedule", "standard_charge_dollar": 11.98, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 17.37, "additional_payer_notes": "Laboratory - 145.00% of Medicare Rates" }, { "payer_name": "Clover Health", "plan_name": "Clover Medicare", "methodology": "fee schedule", "standard_charge_dollar": 11.98, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Coventry", "plan_name": "Coventry Auto", "methodology": "fee schedule", "standard_charge_dollar": 23.96, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Coventry", "plan_name": "Coventry Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 23.96, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "fee schedule", "standard_charge_dollar": 16.77, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Fairprice Healthcare Holdings", "plan_name": "Fairprice Healthcare Holdings", "methodology": "fee schedule", "standard_charge_dollar": 14.38, "additional_payer_notes": "Laboratory - 120.00% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ HMO POS", "methodology": "fee schedule", "standard_charge_dollar": 72.01, "additional_payer_notes": "177.30% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ Indemnity", "methodology": "fee schedule", "standard_charge_dollar": 72.01, "additional_payer_notes": "177.30% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ PPO", "methodology": "fee schedule", "standard_charge_dollar": 72.01, "additional_payer_notes": "177.30% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon Medicare", "methodology": "fee schedule", "standard_charge_dollar": 11.98, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Military Tricare", "methodology": "fee schedule", "standard_charge_dollar": 9.58, "additional_payer_notes": "80.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 11.98, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 11.98, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC All Payer (02-01-2023 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 7.19 }, { "payer_name": "UHC", "plan_name": "UHC Medicaid (02/01/2023 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 9.58 }, { "payer_name": "UHC", "plan_name": "UHC Oxford (02-01-2023 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 7.19 }, { "payer_name": "UHC - Adhoc", "plan_name": "UHC - Adhoc All Payer", "methodology": "fee schedule", "standard_charge_dollar": 11.98 }, { "payer_name": "UHC - Adhoc", "plan_name": "UHC - Adhoc Oxford", "methodology": "fee schedule", "standard_charge_dollar": 11.98 }, { "payer_name": "Wellcare", "plan_name": "Wellcare Insurance Exchange", "methodology": "fee schedule", "standard_charge_dollar": 16.17, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 11.98, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup Medicare", "methodology": "fee schedule", "standard_charge_dollar": 11.98, "additional_payer_notes": "100.00% of Medicare Rates" } ] } ] }, { "description": "Hc Inject Trigger Points, > 3", "code_information": [ { "code": "20553", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 922.46, "discounted_cash": 362.0, "minimum": 176.0976, "maximum": 10939.2, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 769.28, "additional_payer_notes": "212.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medical Rental Network", "methodology": "fee schedule", "standard_charge_dollar": 769.28, "additional_payer_notes": "212.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 362.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "ALLY-ALIGN (FKA SPARTAN PLAN NJ, INC.)", "plan_name": "ALLY-ALIGN (FKA SPARTAN PLAN NJ, INC.)", "methodology": "fee schedule", "standard_charge_dollar": 381.01, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Americhoice (UHC)", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 362.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Amerihealth", "plan_name": "Amerihealth Medicare", "methodology": "fee schedule", "standard_charge_dollar": 362.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 533.24, "additional_payer_notes": "146.95% of Medicare Rates" }, { "payer_name": "Clover Health", "plan_name": "Clover Medicare", "methodology": "fee schedule", "standard_charge_dollar": 362.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Coventry", "plan_name": "Coventry Auto", "methodology": "fee schedule", "standard_charge_dollar": 725.74, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Coventry", "plan_name": "Coventry Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 725.74, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "fee schedule", "standard_charge_dollar": 508.02, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Fairprice Healthcare Holdings", "plan_name": "Fairprice Healthcare Holdings", "methodology": "fee schedule", "standard_charge_dollar": 580.59, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ HMO POS", "methodology": "fee schedule", "standard_charge_dollar": 643.37, "additional_payer_notes": "177.30% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ Indemnity", "methodology": "fee schedule", "standard_charge_dollar": 643.37, "additional_payer_notes": "177.30% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ PPO", "methodology": "fee schedule", "standard_charge_dollar": 643.37, "additional_payer_notes": "177.30% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon Medicare", "methodology": "fee schedule", "standard_charge_dollar": 362.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Military Tricare", "methodology": "fee schedule", "standard_charge_dollar": 290.3, "additional_payer_notes": "80.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 362.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 362.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC All Payer (02-01-2023 to 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 922.46 }, { "payer_name": "UHC", "plan_name": "UHC Oxford (02-01-2023 to 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 922.46 }, { "payer_name": "UHC - Adhoc", "plan_name": "UHC - Adhoc All Payer", "methodology": "case rate", "standard_charge_dollar": 922.46 }, { "payer_name": "UHC - Adhoc", "plan_name": "UHC - Adhoc Oxford", "methodology": "case rate", "standard_charge_dollar": 922.46 }, { "payer_name": "Wellcare", "plan_name": "Wellcare Insurance Exchange", "methodology": "fee schedule", "standard_charge_dollar": 489.87, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 362.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellchoice", "plan_name": "WELLCHOICE HMO of NJ (Empire) Commercial (HMO / HMO POS, PPO)", "methodology": "case rate", "standard_charge_dollar": 922.46 }, { "payer_name": "Wellchoice", "plan_name": "WELLCHOICE HMO of NJ (Empire) Commercial (Indemnity)", "methodology": "case rate", "standard_charge_dollar": 922.46 }, { "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup Medicare", "methodology": "fee schedule", "standard_charge_dollar": 362.87, "additional_payer_notes": "100.00% of Medicare Rates" } ] } ] }, { "description": "MAJOR SKIN DISORDERS WITHOUT MCC", "code_information": [ { "code": "596", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 14066.0, "minimum": 6316.14, "maximum": 25460.546, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "case rate", "standard_charge_dollar": 25460.55, "additional_payer_notes": "181.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medical Rental Network", "methodology": "case rate", "standard_charge_dollar": 25460.55, "additional_payer_notes": "181.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "case rate", "standard_charge_dollar": 11601.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "ALLY-ALIGN (FKA SPARTAN PLAN NJ, INC.)", "plan_name": "ALLY-ALIGN (FKA SPARTAN PLAN NJ, INC.)", "methodology": "case rate", "standard_charge_dollar": 14769.93, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Americhoice (UHC)", "plan_name": "UHC Medicare", "methodology": "case rate", "standard_charge_dollar": 11601.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Amerihealth", "plan_name": "Amerihealth Medicare", "methodology": "case rate", "standard_charge_dollar": 11601.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Commercial", "methodology": "case rate", "standard_charge_dollar": 15836.98 }, { "payer_name": "Clover Health", "plan_name": "Clover Medicare", "methodology": "case rate", "standard_charge_dollar": 11601.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Coventry", "plan_name": "Coventry Auto", "methodology": "case rate", "standard_charge_dollar": 23913.22, "additional_payer_notes": "170.00% of Medicare Rates" }, { "payer_name": "Coventry", "plan_name": "Coventry Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 23913.22, "additional_payer_notes": "170.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "case rate", "standard_charge_dollar": 18286.58, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Fairprice Healthcare Holdings", "plan_name": "Fairprice Healthcare Holdings", "methodology": "case rate", "standard_charge_dollar": 22506.56, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon Medicare", "methodology": "case rate", "standard_charge_dollar": 11601.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon NJ Health Medicaid", "methodology": "case rate", "standard_charge_dollar": 6316.14 }, { "payer_name": "Humana", "plan_name": "Humana Military Tricare", "methodology": "case rate", "standard_charge_dollar": 11253.28, "additional_payer_notes": "80.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 14066.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 7219.39 }, { "payer_name": "UBH", "plan_name": "UBH Medicare", "methodology": "case rate", "standard_charge_dollar": 11601.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC All Payer (02-01-2023 to 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 18246.62 }, { "payer_name": "UHC", "plan_name": "UHC Oxford (02-01-2023 to 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 15901.93 }, { "payer_name": "UHC - Adhoc", "plan_name": "UHC - Adhoc All Payer", "methodology": "case rate", "standard_charge_dollar": 19369.17 }, { "payer_name": "UHC - Adhoc", "plan_name": "UHC - Adhoc Oxford", "methodology": "case rate", "standard_charge_dollar": 16386.89 }, { "payer_name": "Wellcare", "plan_name": "Wellcare Insurance Exchange", "methodology": "case rate", "standard_charge_dollar": 18989.91, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "case rate", "standard_charge_dollar": 11601.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup Medicare", "methodology": "case rate", "standard_charge_dollar": 11601.8, "additional_payer_notes": "100.00% of Medicare Rates" } ] } ] }, { "description": "AMPUTATION FOR CIRCULATORY SYSTEM DISORDERS EXCEPT UPPER LIMB AND TOE WITHOUT CCMCC", "code_information": [ { "code": "241", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 17555.0, "minimum": 9965.96, "maximum": 31775.455, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "case rate", "standard_charge_dollar": 31775.46, "additional_payer_notes": "181.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medical Rental Network", "methodology": "case rate", "standard_charge_dollar": 31775.46, "additional_payer_notes": "181.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "case rate", "standard_charge_dollar": 14403.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "ALLY-ALIGN (FKA SPARTAN PLAN NJ, INC.)", "plan_name": "ALLY-ALIGN (FKA SPARTAN PLAN NJ, INC.)", "methodology": "case rate", "standard_charge_dollar": 18433.28, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Americhoice (UHC)", "plan_name": "UHC Medicare", "methodology": "case rate", "standard_charge_dollar": 14403.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Amerihealth", "plan_name": "Amerihealth Medicare", "methodology": "case rate", "standard_charge_dollar": 14403.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Commercial", "methodology": "case rate", "standard_charge_dollar": 20253.77 }, { "payer_name": "Clover Health", "plan_name": "Clover Medicare", "methodology": "case rate", "standard_charge_dollar": 14403.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Coventry", "plan_name": "Coventry Auto", "methodology": "case rate", "standard_charge_dollar": 29844.35, "additional_payer_notes": "170.00% of Medicare Rates" }, { "payer_name": "Coventry", "plan_name": "Coventry Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 29844.35, "additional_payer_notes": "170.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "case rate", "standard_charge_dollar": 22822.15, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Fairprice Healthcare Holdings", "plan_name": "Fairprice Healthcare Holdings", "methodology": "case rate", "standard_charge_dollar": 28088.8, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon Medicare", "methodology": "case rate", "standard_charge_dollar": 14403.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon NJ Health Medicaid", "methodology": "case rate", "standard_charge_dollar": 9965.96 }, { "payer_name": "Humana", "plan_name": "Humana Military Tricare", "methodology": "case rate", "standard_charge_dollar": 14044.4, "additional_payer_notes": "80.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 17555.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 21967.5 }, { "payer_name": "UBH", "plan_name": "UBH Medicare", "methodology": "case rate", "standard_charge_dollar": 14403.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC All Payer (02-01-2023 to 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 23335.45 }, { "payer_name": "UHC", "plan_name": "UHC Oxford (02-01-2023 to 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 20336.84 }, { "payer_name": "UHC - Adhoc", "plan_name": "UHC - Adhoc All Payer", "methodology": "case rate", "standard_charge_dollar": 24771.07 }, { "payer_name": "UHC - Adhoc", "plan_name": "UHC - Adhoc Oxford", "methodology": "case rate", "standard_charge_dollar": 20957.05 }, { "payer_name": "Wellcare", "plan_name": "Wellcare Insurance Exchange", "methodology": "case rate", "standard_charge_dollar": 23699.93, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "case rate", "standard_charge_dollar": 14403.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup Medicare", "methodology": "case rate", "standard_charge_dollar": 14403.3, "additional_payer_notes": "100.00% of Medicare Rates" } ] } ] }, { "description": "CAUTERIZATION OF CERVIX", "code_information": [ { "code": "57510", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 4809.37, "discounted_cash": 3826.0, "minimum": 918.1087, "maximum": 4809.37, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 4809.37, "additional_payer_notes": "212.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medical Rental Network", "methodology": "fee schedule", "standard_charge_dollar": 4809.37, "additional_payer_notes": "212.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3826.95, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "ALLY-ALIGN (FKA SPARTAN PLAN NJ, INC.)", "plan_name": "ALLY-ALIGN (FKA SPARTAN PLAN NJ, INC.)", "methodology": "fee schedule", "standard_charge_dollar": 4018.3, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Americhoice (UHC)", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3826.95, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Amerihealth", "plan_name": "Amerihealth Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3826.95, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 4809.37, "additional_payer_notes": "146.95% of Medicare Rates" }, { "payer_name": "Clover Health", "plan_name": "Clover Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3826.95, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Coventry", "plan_name": "Coventry Auto", "methodology": "fee schedule", "standard_charge_dollar": 4809.37, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Coventry", "plan_name": "Coventry Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 4809.37, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "fee schedule", "standard_charge_dollar": 4809.37, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Fairprice Healthcare Holdings", "plan_name": "Fairprice Healthcare Holdings", "methodology": "fee schedule", "standard_charge_dollar": 4809.37, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ HMO POS", "methodology": "fee schedule", "standard_charge_dollar": 4809.37, "additional_payer_notes": "177.30% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ Indemnity", "methodology": "fee schedule", "standard_charge_dollar": 4809.37, "additional_payer_notes": "177.30% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ PPO", "methodology": "fee schedule", "standard_charge_dollar": 4809.37, "additional_payer_notes": "177.30% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3826.95, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Military Tricare", "methodology": "fee schedule", "standard_charge_dollar": 3061.56, "additional_payer_notes": "80.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3826.95, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 3826.95, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC All Payer (02-01-2023 to 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 4415.0 }, { "payer_name": "UHC", "plan_name": "UHC Oxford (02-01-2023 to 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 4020.0 }, { "payer_name": "UHC - Adhoc", "plan_name": "UHC - Adhoc All Payer", "methodology": "case rate", "standard_charge_dollar": 4687.0 }, { "payer_name": "UHC - Adhoc", "plan_name": "UHC - Adhoc Oxford", "methodology": "case rate", "standard_charge_dollar": 4143.0 }, { "payer_name": "Wellcare", "plan_name": "Wellcare Insurance Exchange", "methodology": "fee schedule", "standard_charge_dollar": 4809.37, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3826.95, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellchoice", "plan_name": "WELLCHOICE HMO of NJ (Empire) Commercial (HMO / HMO POS, PPO)", "methodology": "case rate", "standard_charge_dollar": 1715.0 }, { "payer_name": "Wellchoice", "plan_name": "WELLCHOICE HMO of NJ (Empire) Commercial (Indemnity)", "methodology": "case rate", "standard_charge_dollar": 1978.0 }, { "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3826.95, "additional_payer_notes": "100.00% of Medicare Rates" } ] } ] }, { "description": "CONNECTIVE TISSUE DISORDERS - SOI : 3", "code_information": [ { "code": "3463", "type": "APR-DRG" } ], "standard_charges": [ { "setting": "inpatient", "minimum": 15780.33, "maximum": 17358.36, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Better Health - Medi Medi", "methodology": "case rate", "standard_charge_dollar": 17358.36, "additional_payer_notes": "110% of State Medicaid Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Better Health Medicaid", "methodology": "case rate", "standard_charge_dollar": 17358.36, "additional_payer_notes": "110% of State Medicaid Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "case rate", "standard_charge_dollar": 15780.33, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "UBH", "plan_name": "UBH Medicaid", "methodology": "case rate", "standard_charge_dollar": 15780.33, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicaid (02/01/2023 to 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 16095.93, "additional_payer_notes": "102% of State Medicaid Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicaid", "methodology": "case rate", "standard_charge_dollar": 15780.33, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup Medicaid", "methodology": "case rate", "standard_charge_dollar": 15780.33, "additional_payer_notes": "100% of State Medicaid Rates" } ] } ] }, { "description": "ANAL AND PERINEAL PROCEDURES- SOI : 3", "code_information": [ { "code": "2263", "type": "APR-DRG" } ], "standard_charges": [ { "setting": "inpatient", "minimum": 18547.88, "maximum": 20402.67, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Better Health - Medi Medi", "methodology": "case rate", "standard_charge_dollar": 20402.67, "additional_payer_notes": "110% of State Medicaid Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Better Health Medicaid", "methodology": "case rate", "standard_charge_dollar": 20402.67, "additional_payer_notes": "110% of State Medicaid Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "case rate", "standard_charge_dollar": 18547.88, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "UBH", "plan_name": "UBH Medicaid", "methodology": "case rate", "standard_charge_dollar": 18547.88, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicaid (02/01/2023 to 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 18918.84, "additional_payer_notes": "102% of State Medicaid Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicaid", "methodology": "case rate", "standard_charge_dollar": 18547.88, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup Medicaid", "methodology": "case rate", "standard_charge_dollar": 18547.88, "additional_payer_notes": "100% of State Medicaid Rates" } ] } ] }, { "description": "NEONATE BIRTHWT 1000-1249G W OR WO OTHER SIGNIFICANT CONDITION - SOI : 4", "code_information": [ { "code": "6034", "type": "APR-DRG" } ], "standard_charges": [ { "setting": "inpatient", "minimum": 164578.16, "maximum": 181035.97, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Better Health - Medi Medi", "methodology": "case rate", "standard_charge_dollar": 181035.97, "additional_payer_notes": "110% of State Medicaid Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Better Health Medicaid", "methodology": "case rate", "standard_charge_dollar": 181035.97, "additional_payer_notes": "110% of State Medicaid Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "case rate", "standard_charge_dollar": 164578.16, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "UBH", "plan_name": "UBH Medicaid", "methodology": "case rate", "standard_charge_dollar": 164578.16, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicaid (02/01/2023 to 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 167869.72, "additional_payer_notes": "102% of State Medicaid Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicaid", "methodology": "case rate", "standard_charge_dollar": 164578.16, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup Medicaid", "methodology": "case rate", "standard_charge_dollar": 164578.16, "additional_payer_notes": "100% of State Medicaid Rates" } ] } ] }, { "description": "Knee arthroscopysurgery - 29873 - ", "code_information": [ { "code": "29873", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 14058.34, "discounted_cash": 3868.0, "minimum": 1715.0, "maximum": 11246.672, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 8200.52, "additional_payer_notes": "212.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medical Rental Network", "methodology": "fee schedule", "standard_charge_dollar": 8200.52, "additional_payer_notes": "212.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3868.17, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "ALLY-ALIGN (FKA SPARTAN PLAN NJ, INC.)", "plan_name": "ALLY-ALIGN (FKA SPARTAN PLAN NJ, INC.)", "methodology": "fee schedule", "standard_charge_dollar": 4061.58, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Americhoice (UHC)", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3868.17, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Amerihealth", "plan_name": "Amerihealth Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3868.17, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 5684.28, "additional_payer_notes": "146.95% of Medicare Rates" }, { "payer_name": "Clover Health", "plan_name": "Clover Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3868.17, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Coventry", "plan_name": "Coventry Auto", "methodology": "fee schedule", "standard_charge_dollar": 7736.34, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Coventry", "plan_name": "Coventry Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 7736.34, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "fee schedule", "standard_charge_dollar": 5415.44, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Fairprice Healthcare Holdings", "plan_name": "Fairprice Healthcare Holdings", "methodology": "fee schedule", "standard_charge_dollar": 6189.07, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ HMO POS", "methodology": "fee schedule", "standard_charge_dollar": 6858.27, "additional_payer_notes": "177.30% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ Indemnity", "methodology": "fee schedule", "standard_charge_dollar": 6858.27, "additional_payer_notes": "177.30% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ PPO", "methodology": "fee schedule", "standard_charge_dollar": 6858.27, "additional_payer_notes": "177.30% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3868.17, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Military Tricare", "methodology": "fee schedule", "standard_charge_dollar": 3094.54, "additional_payer_notes": "80.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3868.17, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 3868.17, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC All Payer (02-01-2023 to 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 5378.0 }, { "payer_name": "UHC", "plan_name": "UHC Oxford (02-01-2023 to 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 5169.0 }, { "payer_name": "UHC - Adhoc", "plan_name": "UHC - Adhoc All Payer", "methodology": "case rate", "standard_charge_dollar": 5709.0 }, { "payer_name": "UHC - Adhoc", "plan_name": "UHC - Adhoc Oxford", "methodology": "case rate", "standard_charge_dollar": 5327.0 }, { "payer_name": "Wellcare", "plan_name": "Wellcare Insurance Exchange", "methodology": "fee schedule", "standard_charge_dollar": 5222.03, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3868.17, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellchoice", "plan_name": "WELLCHOICE HMO of NJ (Empire) Commercial (HMO / HMO POS, PPO)", "methodology": "case rate", "standard_charge_dollar": 1715.0 }, { "payer_name": "Wellchoice", "plan_name": "WELLCHOICE HMO of NJ (Empire) Commercial (Indemnity)", "methodology": "case rate", "standard_charge_dollar": 1978.0 }, { "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3868.17, "additional_payer_notes": "100.00% of Medicare Rates" } ] } ] }, { "description": "CERVICAL SPINAL FUSION WITH CC", "code_information": [ { "code": "472", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 35603.0, "minimum": 18400.8, "maximum": 64441.8644, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "case rate", "standard_charge_dollar": 64441.86, "additional_payer_notes": "181.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medical Rental Network", "methodology": "case rate", "standard_charge_dollar": 64441.86, "additional_payer_notes": "181.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "case rate", "standard_charge_dollar": 28895.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "ALLY-ALIGN (FKA SPARTAN PLAN NJ, INC.)", "plan_name": "ALLY-ALIGN (FKA SPARTAN PLAN NJ, INC.)", "methodology": "case rate", "standard_charge_dollar": 37383.4, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Americhoice (UHC)", "plan_name": "UHC Medicare", "methodology": "case rate", "standard_charge_dollar": 28895.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Amerihealth", "plan_name": "Amerihealth Medicare", "methodology": "case rate", "standard_charge_dollar": 28895.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Commercial", "methodology": "case rate", "standard_charge_dollar": 43101.44 }, { "payer_name": "Clover Health", "plan_name": "Clover Medicare", "methodology": "case rate", "standard_charge_dollar": 28895.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Coventry", "plan_name": "Coventry Auto", "methodology": "case rate", "standard_charge_dollar": 60525.51, "additional_payer_notes": "170.00% of Medicare Rates" }, { "payer_name": "Coventry", "plan_name": "Coventry Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 60525.51, "additional_payer_notes": "170.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "case rate", "standard_charge_dollar": 46284.21, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Fairprice Healthcare Holdings", "plan_name": "Fairprice Healthcare Holdings", "methodology": "case rate", "standard_charge_dollar": 56965.18, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon Medicare", "methodology": "case rate", "standard_charge_dollar": 28895.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon NJ Health Medicaid", "methodology": "case rate", "standard_charge_dollar": 18400.8 }, { "payer_name": "Humana", "plan_name": "Humana Military Tricare", "methodology": "case rate", "standard_charge_dollar": 28482.59, "additional_payer_notes": "80.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 35603.24, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 36141.5 }, { "payer_name": "UBH", "plan_name": "UBH Medicare", "methodology": "case rate", "standard_charge_dollar": 28895.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC All Payer (02-01-2023 to 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 49659.46 }, { "payer_name": "UHC", "plan_name": "UHC Oxford (02-01-2023 to 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 43278.21 }, { "payer_name": "UHC - Adhoc", "plan_name": "UHC - Adhoc All Payer", "methodology": "case rate", "standard_charge_dollar": 52714.57 }, { "payer_name": "UHC - Adhoc", "plan_name": "UHC - Adhoc Oxford", "methodology": "case rate", "standard_charge_dollar": 44598.06 }, { "payer_name": "Wellcare", "plan_name": "Wellcare Insurance Exchange", "methodology": "case rate", "standard_charge_dollar": 48064.37, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "case rate", "standard_charge_dollar": 28895.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup Medicare", "methodology": "case rate", "standard_charge_dollar": 28895.1, "additional_payer_notes": "100.00% of Medicare Rates" } ] } ] }, { "description": "Hc Canalith Repositioning Per Day", "code_information": [ { "code": "95992", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 224.7, "discounted_cash": 32.0, "minimum": 25.648, "maximum": 224.7, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 67.97, "additional_payer_notes": "212.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medical Rental Network", "methodology": "fee schedule", "standard_charge_dollar": 67.97, "additional_payer_notes": "212.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 32.06, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "ALLY-ALIGN (FKA SPARTAN PLAN NJ, INC.)", "plan_name": "ALLY-ALIGN (FKA SPARTAN PLAN NJ, INC.)", "methodology": "fee schedule", "standard_charge_dollar": 33.66, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Americhoice (UHC)", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 32.06, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Amerihealth", "plan_name": "Amerihealth Medicare", "methodology": "fee schedule", "standard_charge_dollar": 32.06, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 49.69, "additional_payer_notes": "A Indicator - 155.00% of Medicare Rates" }, { "payer_name": "Clover Health", "plan_name": "Clover Medicare", "methodology": "fee schedule", "standard_charge_dollar": 32.06, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Coventry", "plan_name": "Coventry Auto", "methodology": "fee schedule", "standard_charge_dollar": 64.12, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Coventry", "plan_name": "Coventry Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 64.12, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "fee schedule", "standard_charge_dollar": 44.88, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Fairprice Healthcare Holdings", "plan_name": "Fairprice Healthcare Holdings", "methodology": "fee schedule", "standard_charge_dollar": 51.3 }, { "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ HMO POS", "methodology": "fee schedule", "standard_charge_dollar": 158.64, "additional_payer_notes": "177.30% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ Indemnity", "methodology": "fee schedule", "standard_charge_dollar": 158.64, "additional_payer_notes": "177.30% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ PPO", "methodology": "fee schedule", "standard_charge_dollar": 158.64, "additional_payer_notes": "177.30% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon Medicare", "methodology": "fee schedule", "standard_charge_dollar": 32.06, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Military Tricare", "methodology": "fee schedule", "standard_charge_dollar": 25.65, "additional_payer_notes": "80.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 32.06, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 32.06, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC All Payer (02-01-2023 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 224.7 }, { "payer_name": "UHC", "plan_name": "UHC Oxford (02-01-2023 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 224.7 }, { "payer_name": "UHC - Adhoc", "plan_name": "UHC - Adhoc All Payer", "methodology": "fee schedule", "standard_charge_dollar": 224.7 }, { "payer_name": "UHC - Adhoc", "plan_name": "UHC - Adhoc Oxford", "methodology": "fee schedule", "standard_charge_dollar": 224.7 }, { "payer_name": "Wellcare", "plan_name": "Wellcare Insurance Exchange", "methodology": "fee schedule", "standard_charge_dollar": 43.28, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 32.06, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup Medicare", "methodology": "fee schedule", "standard_charge_dollar": 32.06, "additional_payer_notes": "100.00% of Medicare Rates" } ] } ] }, { "description": "Hc Angio Visceral Selectv/Subselec", "code_information": [ { "code": "75726", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 21882.6, "discounted_cash": 6578.0, "minimum": 4177.3883, "maximum": 18600.21, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 13946.12, "additional_payer_notes": "212.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medical Rental Network", "methodology": "fee schedule", "standard_charge_dollar": 13946.12, "additional_payer_notes": "212.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 6578.36, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "ALLY-ALIGN (FKA SPARTAN PLAN NJ, INC.)", "plan_name": "ALLY-ALIGN (FKA SPARTAN PLAN NJ, INC.)", "methodology": "fee schedule", "standard_charge_dollar": 6907.28, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Americhoice (UHC)", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 6578.36, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Amerihealth", "plan_name": "Amerihealth Medicare", "methodology": "fee schedule", "standard_charge_dollar": 6578.36, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 9666.9, "additional_payer_notes": "146.95% of Medicare Rates" }, { "payer_name": "Clover Health", "plan_name": "Clover Medicare", "methodology": "fee schedule", "standard_charge_dollar": 6578.36, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Coventry", "plan_name": "Coventry Auto", "methodology": "fee schedule", "standard_charge_dollar": 13156.72, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Coventry", "plan_name": "Coventry Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 13156.72, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "fee schedule", "standard_charge_dollar": 9209.7, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Fairprice Healthcare Holdings", "plan_name": "Fairprice Healthcare Holdings", "methodology": "fee schedule", "standard_charge_dollar": 10525.38, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ HMO POS", "methodology": "fee schedule", "standard_charge_dollar": 11663.43, "additional_payer_notes": "177.30% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ Indemnity", "methodology": "fee schedule", "standard_charge_dollar": 11663.43, "additional_payer_notes": "177.30% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ PPO", "methodology": "fee schedule", "standard_charge_dollar": 11663.43, "additional_payer_notes": "177.30% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon Medicare", "methodology": "fee schedule", "standard_charge_dollar": 6578.36, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Military Tricare", "methodology": "fee schedule", "standard_charge_dollar": 5262.69, "additional_payer_notes": "80.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 6578.36, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 6578.36, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC All Payer (02-01-2023 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 7155.56 }, { "payer_name": "UHC", "plan_name": "UHC Oxford (02-01-2023 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 7155.56 }, { "payer_name": "UHC - Adhoc", "plan_name": "UHC - Adhoc All Payer", "methodology": "fee schedule", "standard_charge_dollar": 4770.37 }, { "payer_name": "UHC - Adhoc", "plan_name": "UHC - Adhoc Oxford", "methodology": "fee schedule", "standard_charge_dollar": 4770.37 }, { "payer_name": "Wellcare", "plan_name": "Wellcare Insurance Exchange", "methodology": "fee schedule", "standard_charge_dollar": 8880.79, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 6578.36, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup Medicare", "methodology": "fee schedule", "standard_charge_dollar": 6578.36, "additional_payer_notes": "100.00% of Medicare Rates" } ] } ] }, { "description": "Release muscles of hand", "code_information": [ { "code": "26593", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 9376.25, "discounted_cash": 3868.0, "minimum": 1715.0, "maximum": 8200.5204, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 8200.52, "additional_payer_notes": "212.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medical Rental Network", "methodology": "fee schedule", "standard_charge_dollar": 8200.52, "additional_payer_notes": "212.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3868.17, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "ALLY-ALIGN (FKA SPARTAN PLAN NJ, INC.)", "plan_name": "ALLY-ALIGN (FKA SPARTAN PLAN NJ, INC.)", "methodology": "fee schedule", "standard_charge_dollar": 4061.58, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Americhoice (UHC)", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3868.17, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Amerihealth", "plan_name": "Amerihealth Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3868.17, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 5684.28, "additional_payer_notes": "146.95% of Medicare Rates" }, { "payer_name": "Clover Health", "plan_name": "Clover Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3868.17, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Coventry", "plan_name": "Coventry Auto", "methodology": "fee schedule", "standard_charge_dollar": 7736.34, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Coventry", "plan_name": "Coventry Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 7736.34, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "fee schedule", "standard_charge_dollar": 5415.44, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Fairprice Healthcare Holdings", "plan_name": "Fairprice Healthcare Holdings", "methodology": "fee schedule", "standard_charge_dollar": 6189.07, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ HMO POS", "methodology": "fee schedule", "standard_charge_dollar": 6858.27, "additional_payer_notes": "177.30% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ Indemnity", "methodology": "fee schedule", "standard_charge_dollar": 6858.27, "additional_payer_notes": "177.30% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ PPO", "methodology": "fee schedule", "standard_charge_dollar": 6858.27, "additional_payer_notes": "177.30% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3868.17, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon NJ Health Medicaid", "methodology": "percent of total billed charges", "standard_charge_percentage": 19.58, "median_amount": 1694.65, "10th_percentile": 1694.65, "90th_percentile": 1694.65, "count": "1 through 10" }, { "payer_name": "Humana", "plan_name": "Humana Military Tricare", "methodology": "fee schedule", "standard_charge_dollar": 3094.54, "additional_payer_notes": "80.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3868.17, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 3868.17, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC All Payer (02-01-2023 to 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 3912.0 }, { "payer_name": "UHC", "plan_name": "UHC Oxford (02-01-2023 to 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 3676.0 }, { "payer_name": "UHC - Adhoc", "plan_name": "UHC - Adhoc All Payer", "methodology": "case rate", "standard_charge_dollar": 4153.0 }, { "payer_name": "UHC - Adhoc", "plan_name": "UHC - Adhoc Oxford", "methodology": "case rate", "standard_charge_dollar": 3788.0 }, { "payer_name": "Wellcare", "plan_name": "Wellcare Insurance Exchange", "methodology": "fee schedule", "standard_charge_dollar": 5222.03, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3868.17, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellchoice", "plan_name": "WELLCHOICE HMO of NJ (Empire) Commercial (HMO / HMO POS, PPO)", "methodology": "case rate", "standard_charge_dollar": 1715.0 }, { "payer_name": "Wellchoice", "plan_name": "WELLCHOICE HMO of NJ (Empire) Commercial (Indemnity)", "methodology": "case rate", "standard_charge_dollar": 1978.0 }, { "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3868.17, "additional_payer_notes": "100.00% of Medicare Rates" } ] } ] }, { "description": "Hc Clsd Treat Traumatic Hip Disloc Wo Anes", "code_information": [ { "code": "27250", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 839.01, "discounted_cash": 291.0, "minimum": 160.167, "maximum": 839.01, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 618.19, "additional_payer_notes": "212.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medical Rental Network", "methodology": "fee schedule", "standard_charge_dollar": 618.19, "additional_payer_notes": "212.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 291.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "ALLY-ALIGN (FKA SPARTAN PLAN NJ, INC.)", "plan_name": "ALLY-ALIGN (FKA SPARTAN PLAN NJ, INC.)", "methodology": "fee schedule", "standard_charge_dollar": 306.18, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Americhoice (UHC)", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 291.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Amerihealth", "plan_name": "Amerihealth Medicare", "methodology": "fee schedule", "standard_charge_dollar": 291.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 428.51, "additional_payer_notes": "146.95% of Medicare Rates" }, { "payer_name": "Clover Health", "plan_name": "Clover Medicare", "methodology": "fee schedule", "standard_charge_dollar": 291.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Coventry", "plan_name": "Coventry Auto", "methodology": "fee schedule", "standard_charge_dollar": 583.2, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Coventry", "plan_name": "Coventry Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 583.2, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "fee schedule", "standard_charge_dollar": 408.24, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Fairprice Healthcare Holdings", "plan_name": "Fairprice Healthcare Holdings", "methodology": "fee schedule", "standard_charge_dollar": 466.56, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ HMO POS", "methodology": "fee schedule", "standard_charge_dollar": 517.01, "additional_payer_notes": "177.30% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ Indemnity", "methodology": "fee schedule", "standard_charge_dollar": 517.01, "additional_payer_notes": "177.30% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ PPO", "methodology": "fee schedule", "standard_charge_dollar": 517.01, "additional_payer_notes": "177.30% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon Medicare", "methodology": "fee schedule", "standard_charge_dollar": 291.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Military Tricare", "methodology": "fee schedule", "standard_charge_dollar": 233.28, "additional_payer_notes": "80.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 291.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 291.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC All Payer (02-01-2023 to 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 839.01 }, { "payer_name": "UHC", "plan_name": "UHC Oxford (02-01-2023 to 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 839.01 }, { "payer_name": "UHC - Adhoc", "plan_name": "UHC - Adhoc All Payer", "methodology": "case rate", "standard_charge_dollar": 839.01 }, { "payer_name": "UHC - Adhoc", "plan_name": "UHC - Adhoc Oxford", "methodology": "case rate", "standard_charge_dollar": 839.01 }, { "payer_name": "Wellcare", "plan_name": "Wellcare Insurance Exchange", "methodology": "fee schedule", "standard_charge_dollar": 393.66, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 291.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup Medicare", "methodology": "fee schedule", "standard_charge_dollar": 291.6, "additional_payer_notes": "100.00% of Medicare Rates" } ] } ] }, { "description": "URINARY STONES WITHOUT MCC", "code_information": [ { "code": "694", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 10590.0, "minimum": 4384.15, "maximum": 19168.6421, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "case rate", "standard_charge_dollar": 19168.64, "additional_payer_notes": "181.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medical Rental Network", "methodology": "case rate", "standard_charge_dollar": 19168.64, "additional_payer_notes": "181.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "case rate", "standard_charge_dollar": 8810.53, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "ALLY-ALIGN (FKA SPARTAN PLAN NJ, INC.)", "plan_name": "ALLY-ALIGN (FKA SPARTAN PLAN NJ, INC.)", "methodology": "case rate", "standard_charge_dollar": 11119.93, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Americhoice (UHC)", "plan_name": "UHC Medicare", "methodology": "case rate", "standard_charge_dollar": 8810.53, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Amerihealth", "plan_name": "Amerihealth Medicare", "methodology": "case rate", "standard_charge_dollar": 8810.53, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Commercial", "methodology": "case rate", "standard_charge_dollar": 11436.27 }, { "payer_name": "Clover Health", "plan_name": "Clover Medicare", "methodology": "case rate", "standard_charge_dollar": 8810.53, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Coventry", "plan_name": "Coventry Auto", "methodology": "case rate", "standard_charge_dollar": 18003.7, "additional_payer_notes": "170.00% of Medicare Rates" }, { "payer_name": "Coventry", "plan_name": "Coventry Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 18003.7, "additional_payer_notes": "170.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "case rate", "standard_charge_dollar": 13767.53, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Fairprice Healthcare Holdings", "plan_name": "Fairprice Healthcare Holdings", "methodology": "case rate", "standard_charge_dollar": 16944.66, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon Medicare", "methodology": "case rate", "standard_charge_dollar": 8810.53, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon NJ Health Medicaid", "methodology": "case rate", "standard_charge_dollar": 4384.15 }, { "payer_name": "Humana", "plan_name": "Humana Military Tricare", "methodology": "case rate", "standard_charge_dollar": 8472.33, "additional_payer_notes": "80.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 10590.41, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 7612.61 }, { "payer_name": "UBH", "plan_name": "UBH Medicare", "methodology": "case rate", "standard_charge_dollar": 8810.53, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC All Payer (02-01-2023 to 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 13176.34 }, { "payer_name": "UHC", "plan_name": "UHC Oxford (02-01-2023 to 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 11483.17 }, { "payer_name": "UHC - Adhoc", "plan_name": "UHC - Adhoc All Payer", "methodology": "case rate", "standard_charge_dollar": 13986.96 }, { "payer_name": "UHC - Adhoc", "plan_name": "UHC - Adhoc Oxford", "methodology": "case rate", "standard_charge_dollar": 11833.37 }, { "payer_name": "Wellcare", "plan_name": "Wellcare Insurance Exchange", "methodology": "case rate", "standard_charge_dollar": 14297.05, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "case rate", "standard_charge_dollar": 8810.53, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup Medicare", "methodology": "case rate", "standard_charge_dollar": 8810.53, "additional_payer_notes": "100.00% of Medicare Rates" } ] } ] }, { "description": "Hc Exc Skin Benig 0.6-1 Cm Scalp/Neck/Hnd/Ft/Gent", "code_information": [ { "code": "11421", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 2515.34, "discounted_cash": 837.0, "minimum": 480.1784, "maximum": 12335.28, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 1774.76, "additional_payer_notes": "212.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medical Rental Network", "methodology": "fee schedule", "standard_charge_dollar": 1774.76, "additional_payer_notes": "212.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 837.15, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "ALLY-ALIGN (FKA SPARTAN PLAN NJ, INC.)", "plan_name": "ALLY-ALIGN (FKA SPARTAN PLAN NJ, INC.)", "methodology": "fee schedule", "standard_charge_dollar": 879.01, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Americhoice (UHC)", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 837.15, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Amerihealth", "plan_name": "Amerihealth Medicare", "methodology": "fee schedule", "standard_charge_dollar": 837.15, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 1230.19, "additional_payer_notes": "146.95% of Medicare Rates" }, { "payer_name": "Clover Health", "plan_name": "Clover Medicare", "methodology": "fee schedule", "standard_charge_dollar": 837.15, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Coventry", "plan_name": "Coventry Auto", "methodology": "fee schedule", "standard_charge_dollar": 1674.3, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Coventry", "plan_name": "Coventry Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 1674.3, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "fee schedule", "standard_charge_dollar": 1172.01, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Fairprice Healthcare Holdings", "plan_name": "Fairprice Healthcare Holdings", "methodology": "fee schedule", "standard_charge_dollar": 1339.44, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ HMO POS", "methodology": "fee schedule", "standard_charge_dollar": 1484.27, "additional_payer_notes": "177.30% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ Indemnity", "methodology": "fee schedule", "standard_charge_dollar": 1484.27, "additional_payer_notes": "177.30% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ PPO", "methodology": "fee schedule", "standard_charge_dollar": 1484.27, "additional_payer_notes": "177.30% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon Medicare", "methodology": "fee schedule", "standard_charge_dollar": 837.15, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Military Tricare", "methodology": "fee schedule", "standard_charge_dollar": 669.72, "additional_payer_notes": "80.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 837.15, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 837.15, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC All Payer (02-01-2023 to 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 2515.34 }, { "payer_name": "UHC", "plan_name": "UHC Oxford (02-01-2023 to 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 2297.0 }, { "payer_name": "UHC - Adhoc", "plan_name": "UHC - Adhoc All Payer", "methodology": "case rate", "standard_charge_dollar": 2515.34 }, { "payer_name": "UHC - Adhoc", "plan_name": "UHC - Adhoc Oxford", "methodology": "case rate", "standard_charge_dollar": 2367.0 }, { "payer_name": "Wellcare", "plan_name": "Wellcare Insurance Exchange", "methodology": "fee schedule", "standard_charge_dollar": 1130.15, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 837.15, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellchoice", "plan_name": "WELLCHOICE HMO of NJ (Empire) Commercial (HMO / HMO POS, PPO)", "methodology": "case rate", "standard_charge_dollar": 1715.0 }, { "payer_name": "Wellchoice", "plan_name": "WELLCHOICE HMO of NJ (Empire) Commercial (Indemnity)", "methodology": "case rate", "standard_charge_dollar": 1978.0 }, { "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup Medicare", "methodology": "fee schedule", "standard_charge_dollar": 837.15, "additional_payer_notes": "100.00% of Medicare Rates" } ] } ] }, { "description": "Hc Vlvp Mitral Valve W/Bypass Rad Rcnstj W/Wo Ring", "code_information": [ { "code": "33427", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 551.8, "minimum": 105.3386, "maximum": 551.8, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 551.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC All Payer (02-01-2023 to 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 551.8 }, { "payer_name": "UHC", "plan_name": "UHC Oxford (02-01-2023 to 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 551.8 }, { "payer_name": "UHC - Adhoc", "plan_name": "UHC - Adhoc All Payer", "methodology": "case rate", "standard_charge_dollar": 551.8 }, { "payer_name": "UHC - Adhoc", "plan_name": "UHC - Adhoc Oxford", "methodology": "case rate", "standard_charge_dollar": 551.8 }, { "payer_name": "Wellchoice", "plan_name": "WELLCHOICE HMO of NJ (Empire) Commercial (HMO / HMO POS, PPO)", "methodology": "case rate", "standard_charge_dollar": 551.8 }, { "payer_name": "Wellchoice", "plan_name": "WELLCHOICE HMO of NJ (Empire) Commercial (Indemnity)", "methodology": "case rate", "standard_charge_dollar": 551.8 } ] } ] }, { "description": "HEART FAILURE AND SHOCK WITH MCC", "code_information": [ { "code": "291", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 16392.0, "minimum": 8401.13, "maximum": 29671.1852, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "case rate", "standard_charge_dollar": 29671.19, "additional_payer_notes": "181.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medical Rental Network", "methodology": "case rate", "standard_charge_dollar": 29671.19, "additional_payer_notes": "181.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "case rate", "standard_charge_dollar": 13469.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "ALLY-ALIGN (FKA SPARTAN PLAN NJ, INC.)", "plan_name": "ALLY-ALIGN (FKA SPARTAN PLAN NJ, INC.)", "methodology": "case rate", "standard_charge_dollar": 17212.57, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Americhoice (UHC)", "plan_name": "UHC Medicare", "methodology": "case rate", "standard_charge_dollar": 13469.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Amerihealth", "plan_name": "Amerihealth Medicare", "methodology": "case rate", "standard_charge_dollar": 13469.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Commercial", "methodology": "case rate", "standard_charge_dollar": 18781.99 }, { "payer_name": "Clover Health", "plan_name": "Clover Medicare", "methodology": "case rate", "standard_charge_dollar": 13469.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Coventry", "plan_name": "Coventry Auto", "methodology": "case rate", "standard_charge_dollar": 27867.96, "additional_payer_notes": "170.00% of Medicare Rates" }, { "payer_name": "Coventry", "plan_name": "Coventry Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 27867.96, "additional_payer_notes": "170.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "case rate", "standard_charge_dollar": 21310.8, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Fairprice Healthcare Holdings", "plan_name": "Fairprice Healthcare Holdings", "methodology": "case rate", "standard_charge_dollar": 26228.67, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon Medicare", "methodology": "case rate", "standard_charge_dollar": 13469.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon NJ Health Medicaid", "methodology": "case rate", "standard_charge_dollar": 8401.13 }, { "payer_name": "Humana", "plan_name": "Humana Military Tricare", "methodology": "case rate", "standard_charge_dollar": 13114.34, "additional_payer_notes": "80.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 16392.92, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 14142.6 }, { "payer_name": "UBH", "plan_name": "UBH Medicare", "methodology": "case rate", "standard_charge_dollar": 13469.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC All Payer (02-01-2023 to 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 21639.73 }, { "payer_name": "UHC", "plan_name": "UHC Oxford (02-01-2023 to 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 18859.02 }, { "payer_name": "UHC - Adhoc", "plan_name": "UHC - Adhoc All Payer", "methodology": "case rate", "standard_charge_dollar": 22971.03 }, { "payer_name": "UHC - Adhoc", "plan_name": "UHC - Adhoc Oxford", "methodology": "case rate", "standard_charge_dollar": 19434.16 }, { "payer_name": "Wellcare", "plan_name": "Wellcare Insurance Exchange", "methodology": "case rate", "standard_charge_dollar": 22130.44, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "case rate", "standard_charge_dollar": 13469.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup Medicare", "methodology": "case rate", "standard_charge_dollar": 13469.8, "additional_payer_notes": "100.00% of Medicare Rates" } ] } ] }, { "description": "PELVIC EVISCERATION, RADICAL HYSTERECTOMY & OTHER RADICAL GYN PROCS - SOI : 4", "code_information": [ { "code": "5104", "type": "APR-DRG" } ], "standard_charges": [ { "setting": "inpatient", "minimum": 60793.21, "maximum": 66872.53, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Better Health - Medi Medi", "methodology": "case rate", "standard_charge_dollar": 66872.53, "additional_payer_notes": "110% of State Medicaid Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Better Health Medicaid", "methodology": "case rate", "standard_charge_dollar": 66872.53, "additional_payer_notes": "110% of State Medicaid Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "case rate", "standard_charge_dollar": 60793.21, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "UBH", "plan_name": "UBH Medicaid", "methodology": "case rate", "standard_charge_dollar": 60793.21, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicaid (02/01/2023 to 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 62009.07, "additional_payer_notes": "102% of State Medicaid Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicaid", "methodology": "case rate", "standard_charge_dollar": 60793.21, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup Medicaid", "methodology": "case rate", "standard_charge_dollar": 60793.21, "additional_payer_notes": "100% of State Medicaid Rates" } ] } ] }, { "description": "Hc Office/Outpatient Established Sf Mdm 10-19 Min - G0463 - 76100007", "code_information": [ { "code": "G0463", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 542.65, "discounted_cash": 157.0, "minimum": 19.09, "maximum": 1131.35, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 333.67, "additional_payer_notes": "212.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medical Rental Network", "methodology": "fee schedule", "standard_charge_dollar": 333.67, "additional_payer_notes": "212.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 157.39, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "ALLY-ALIGN (FKA SPARTAN PLAN NJ, INC.)", "plan_name": "ALLY-ALIGN (FKA SPARTAN PLAN NJ, INC.)", "methodology": "fee schedule", "standard_charge_dollar": 165.26, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Americhoice (UHC)", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 157.39, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Amerihealth", "plan_name": "Amerihealth Medicare", "methodology": "fee schedule", "standard_charge_dollar": 157.39, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 231.28, "additional_payer_notes": "146.95% of Medicare Rates" }, { "payer_name": "Clover Health", "plan_name": "Clover Medicare", "methodology": "fee schedule", "standard_charge_dollar": 157.39, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Coventry", "plan_name": "Coventry Auto", "methodology": "fee schedule", "standard_charge_dollar": 314.78, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Coventry", "plan_name": "Coventry Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 314.78, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "fee schedule", "standard_charge_dollar": 220.35, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Fairprice Healthcare Holdings", "plan_name": "Fairprice Healthcare Holdings", "methodology": "fee schedule", "standard_charge_dollar": 251.82, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ HMO POS", "methodology": "fee schedule", "standard_charge_dollar": 279.05, "additional_payer_notes": "177.30% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ Indemnity", "methodology": "fee schedule", "standard_charge_dollar": 279.05, "additional_payer_notes": "177.30% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ PPO", "methodology": "fee schedule", "standard_charge_dollar": 279.05, "additional_payer_notes": "177.30% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon Medicare", "methodology": "fee schedule", "standard_charge_dollar": 157.39, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Military Tricare", "methodology": "fee schedule", "standard_charge_dollar": 125.91, "additional_payer_notes": "80.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 157.39, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 157.39, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Insurance Exchange", "methodology": "fee schedule", "standard_charge_dollar": 212.48, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 157.39, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup Medicare", "methodology": "fee schedule", "standard_charge_dollar": 157.39, "additional_payer_notes": "100.00% of Medicare Rates" } ] } ] }, { "description": "Hc Remove Nasal Fb", "code_information": [ { "code": "30300", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 524.41, "discounted_cash": 157.0, "minimum": 100.1099, "maximum": 524.41, "payers_information": [ { "payer_name": "Wellcare", "plan_name": "Wellcare Insurance Exchange", "methodology": "fee schedule", "standard_charge_dollar": 212.34, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 157.29, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellchoice", "plan_name": "WELLCHOICE HMO of NJ (Empire) Commercial (HMO / HMO POS, PPO)", "methodology": "case rate", "standard_charge_dollar": 524.41 }, { "payer_name": "Wellchoice", "plan_name": "WELLCHOICE HMO of NJ (Empire) Commercial (Indemnity)", "methodology": "case rate", "standard_charge_dollar": 524.41 }, { "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup Medicare", "methodology": "fee schedule", "standard_charge_dollar": 157.29, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 333.45, "additional_payer_notes": "212.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medical Rental Network", "methodology": "fee schedule", "standard_charge_dollar": 333.45, "additional_payer_notes": "212.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 157.29, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "ALLY-ALIGN (FKA SPARTAN PLAN NJ, INC.)", "plan_name": "ALLY-ALIGN (FKA SPARTAN PLAN NJ, INC.)", "methodology": "fee schedule", "standard_charge_dollar": 165.15, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Americhoice (UHC)", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 157.29, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Amerihealth", "plan_name": "Amerihealth Medicare", "methodology": "fee schedule", "standard_charge_dollar": 157.29, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 231.14, "additional_payer_notes": "146.95% of Medicare Rates" }, { "payer_name": "Clover Health", "plan_name": "Clover Medicare", "methodology": "fee schedule", "standard_charge_dollar": 157.29, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Coventry", "plan_name": "Coventry Auto", "methodology": "fee schedule", "standard_charge_dollar": 314.58, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Coventry", "plan_name": "Coventry Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 314.58, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "fee schedule", "standard_charge_dollar": 220.21, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Fairprice Healthcare Holdings", "plan_name": "Fairprice Healthcare Holdings", "methodology": "fee schedule", "standard_charge_dollar": 251.66, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ HMO POS", "methodology": "fee schedule", "standard_charge_dollar": 278.88, "additional_payer_notes": "177.30% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ Indemnity", "methodology": "fee schedule", "standard_charge_dollar": 278.88, "additional_payer_notes": "177.30% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ PPO", "methodology": "fee schedule", "standard_charge_dollar": 278.88, "additional_payer_notes": "177.30% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon Medicare", "methodology": "fee schedule", "standard_charge_dollar": 157.29, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Military Tricare", "methodology": "fee schedule", "standard_charge_dollar": 125.83, "additional_payer_notes": "80.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 157.29, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 157.29, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC All Payer (02-01-2023 to 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 524.41 }, { "payer_name": "UHC", "plan_name": "UHC Oxford (02-01-2023 to 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 524.41 }, { "payer_name": "UHC - Adhoc", "plan_name": "UHC - Adhoc All Payer", "methodology": "case rate", "standard_charge_dollar": 524.41 }, { "payer_name": "UHC - Adhoc", "plan_name": "UHC - Adhoc Oxford", "methodology": "case rate", "standard_charge_dollar": 524.41 } ] } ] }, { "description": "Hc Q Fever Antibody", "code_information": [ { "code": "86638", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 46.0, "discounted_cash": 12.0, "minimum": 7.27, "maximum": 39.1, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 25.69, "additional_payer_notes": "212.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medical Rental Network", "methodology": "fee schedule", "standard_charge_dollar": 25.69, "additional_payer_notes": "212.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 12.12, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "ALLY-ALIGN (FKA SPARTAN PLAN NJ, INC.)", "plan_name": "ALLY-ALIGN (FKA SPARTAN PLAN NJ, INC.)", "methodology": "fee schedule", "standard_charge_dollar": 12.73, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Americhoice (UHC)", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 12.12, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Amerihealth", "plan_name": "Amerihealth Medicare", "methodology": "fee schedule", "standard_charge_dollar": 12.12, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 17.57, "additional_payer_notes": "Laboratory - 145.00% of Medicare Rates" }, { "payer_name": "Clover Health", "plan_name": "Clover Medicare", "methodology": "fee schedule", "standard_charge_dollar": 12.12, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Coventry", "plan_name": "Coventry Auto", "methodology": "fee schedule", "standard_charge_dollar": 24.24, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Coventry", "plan_name": "Coventry Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 24.24, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "fee schedule", "standard_charge_dollar": 16.97, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Fairprice Healthcare Holdings", "plan_name": "Fairprice Healthcare Holdings", "methodology": "fee schedule", "standard_charge_dollar": 14.54, "additional_payer_notes": "Laboratory - 120.00% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ HMO POS", "methodology": "fee schedule", "standard_charge_dollar": 32.48, "additional_payer_notes": "177.30% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ Indemnity", "methodology": "fee schedule", "standard_charge_dollar": 32.48, "additional_payer_notes": "177.30% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ PPO", "methodology": "fee schedule", "standard_charge_dollar": 32.48, "additional_payer_notes": "177.30% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon Medicare", "methodology": "fee schedule", "standard_charge_dollar": 12.12, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Military Tricare", "methodology": "fee schedule", "standard_charge_dollar": 9.7, "additional_payer_notes": "80.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_